Three-month experience with tacrolimus once-daily regimen in stable renal allografts.

INTRODUCTION: MR-4, the new oral formulation of tacrolimus that allows once-daily dosing, may improve patient compliance. The purpose of this study was to evaluate the safety and efficacy parameters among a group of stable renal allografts after conversion to MR-4. METHODS: We enrolled 82 stable kidney recipients, who had received their grafts 43.9 +/- 38.3 months prior. They were of mean age 56 +/- 12 years and included 70.7% men. Sixty-six patients were converted on a milligram-for-milligram basis from their total daily dose; the remaining patients were converted at the physician's discretion. Three patients were excluded: 1 because of the development of abdominal pain, and 2 because of dosing errors. Tacrolimus trough levels and renal function tests were evaluated at entry and on days 7, 30, and 90. RESULTS: Only 5 (7.6%) converted patients required a later dose adjustment. In the group of 61 patients who did not require this adjustment, the mean tacrolimus trough levels decreased during the first week (6.8 +/- 1.7 to 5.8 +/- 2.0; P < .000). Thirty-eight patients completed 3 months of follow-up. Their tacrolimus trough levels, serum creatinine levels, and proteinuria remained stable. The number of capsules per patient needed after the conversion to MR-4 was lower (3.9 +/- 1.6 versus 2.9 +/- 1.0; P < .000). There were no cases of acute rejection episodes. CONCLUSION: Based on a milligram-for-milligram conversion, only 7.6% of our patients required a dose adjustment. With this conversion, an initial decrease in tacrolimus trough levels was documented at day 7, which remained stable to the end of the study. The patients needed a lower number of capsules. These results supported the safety of MR-4.

[Treating high blood pressure in kidney patients: evidence and implications]. / Tratamiento de la hipertensión arterial en pacientes con enfermedad renal crónica. Evidencias e implicaciones.

The main aim delaying progression of chronic kidney disease (CKD) are tight control of blood pressure to levels below 130/80 mmHg and reductioner 24-h urine protein to <0.5 g or microalbuminuria to <300 mg/g. First-line agents for renoprotection are angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers at the highest tolerated dose. The combination of these types of drugs, the so-called dual blockade, further reduces an elevated urinary albumin or protein excretion but, at least in patients at high cardiovascular risk, does not delay progression of renal failure. An intensified multifactorial intervention is necessary for renal patients because 35 to 50% of cases with grade 3 or 4 CKD are prone to premature complications such as end-stage renal disease and/or cardiovascular events. New strategies to block the renin-angiotensin system could be of help in improving of outcomes in CKD patients.

Tratamiento de la hipertensión arterial en pacientes con enfermedad renal crónica. Evidencias e implicaciones / Treating high blood pressure in Kidney patients: evidence and implications

Los principales objetivos para diferir la progresión de la enfermedad renal crónica (ERC) son el control de la presión arterial a valores < 130/80 mmHg y de, modo independiente, la reducción de la proteinuria a cifras < 0,5 g/24 h (microalbuminuria < 300 mg/g). Los fármacos del primer escalón terapéutico son los inhibidores de la enzima de conversión de la angiotensina y los antagonistas de los receptores de la angiotensina II a las dosis máximas toleradas. La combinación de ambos incrementa su efecto antiproteinúrico, pero en pacientes con alto riesgo vascular no reduce la progresión de la insuficiencia renal. El control de los pacientes con ERC precisa de un tratamiento terapéutico multifactorial que debe establecerse de forma temprana e intensiva. Un 35-50% de pacientes con ERC de estadios 3-4 y proteinuria significativa progresan en un plazo medio a enfermedad renal terminal o mueren previamente por complicaciones cardiovasculares, por lo que pueden ser oportunas nuevas estrategias para bloquear el sistema renina-angiotensina (AU)

The main aim delaying progression of chronic kidney disease (CKD) are tight control of blood pressure to levels below 130/80 mmHg and reductioner 24-h urine proteine to < 0.5 g or microalbuminuria to < 300 mg/g. First-line agents for renoprotection are angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers at the higherst toleratedose. The combination of these types of drugs, the so-called dual blockade, further reduces an elevated urinary albumin or protein excretion but, at least in patients at high cardiovascular risk, does not delay progression of renal failure. An intensified multifactorial intervention is necessary for renal patients because 35 to 50% of cases with grade 3 or 4 CKD are prone to premature complications such as end-stage renal disease and/or cardiovascular events. New strategies to block the renin-angiotensin system could be of help in improving of outcomes in CKD patients (AU)