Higgins Robert, Ramaiyan Karam, Dasgupta Tanaji, Kanji Hemali, Fletcher Simon, Lam For, Kashi Habib
Renal Transplant Unit, University Hospitals Coventry and Warwickshire, Walsgrave Hospital, Coventry, UK.
Nephrol Dial Transplant. 2004 Feb;19(2):444-50. doi: 10.1093/ndt/gfg515.
This study was designed to examine the hypothesis that the nephrotoxicities caused by cyclosporin and tacrolimus might differ in respect of sodium and potassium handling.
125 patients were studied retrospectively for the first 90 days after renal transplantation. Eighty were treated initially with cyclosporin and 45 with tacrolimus.
A serum sodium level of <135 mmol/l was present for 542/5171 (10.5%) days under tacrolimus treatment compared with 377/5486 (6.9%) days under cyclosporin treatment (P < 0.0001). Severe hyponatraemia, below 120 mmol/l, was also more prevalent under tacrolimus than cyclosporin treatment, P < 0.025. Nine patients, all receiving tacrolimus, were treated with fludrocortisone for fluid depletion and/or hyponatraemia. Serum potassium levels were higher in tacrolimus-treated patients (P < 0.0001), and subjects with hyponatraemia were more likely to experience hyperkalaemia (P < 0.0001).
Hyponatraemia and hyperkalaemia were more frequent in tacrolimus-treated subjects. Taken together with previous work showing that hyperuricaemia is more frequent with cyclosporin treatment, and hypomagnesaemia with tacrolimus treatment, these findings are consistent with qualitative differences between the nephrotoxicities of cyclosporin and tacrolimus.
本研究旨在检验环孢素和他克莫司引起的肾毒性在钠和钾处理方面可能存在差异的假设。
对125例肾移植患者术后前90天进行回顾性研究。其中80例初始接受环孢素治疗，45例接受他克莫司治疗。
他克莫司治疗期间血清钠水平<135 mmol/l的天数为542/5171天（10.5%），而环孢素治疗期间为377/5486天（6.9%）（P<0.0001）。严重低钠血症（低于120 mmol/l）在他克莫司治疗组也比环孢素治疗组更常见，P<0.025。9例均接受他克莫司治疗的患者因液体耗竭和/或低钠血症接受了氟氢可的松治疗。他克莫司治疗患者的血清钾水平较高（P<0.0001），低钠血症患者更易发生高钾血症（P<0.0001）。
他克莫司治疗的患者低钠血症和高钾血症更为常见。结合之前的研究结果，即环孢素治疗高尿酸血症更常见，他克莫司治疗低镁血症更常见，这些发现与环孢素和他克莫司肾毒性的质性差异一致。
