Clinical and Experimental Nephrology

, Volume 17, Issue 5, pp 743–749

Excess fluid distribution affects tacrolimus absorption in peritoneal dialysis patients

  • Tadashi Sofue
  • Masashi Inui
  • Hideyasu Kiyomoto
  • Kumiko Moriwaki
  • Taiga Hara
  • Kazunori Yamaguchi
  • Noriyasu Fukuoka
  • Kazuko Banno
  • Akira Nishiyama
  • Yoshiyuki Kakehi
  • Masakazu Kohno
Original Article



Excess fluid distribution is a common disorder in peritoneal dialysis (PD) patients. Tacrolimus malabsorption may also occur in PD patients, and may lead to acute allograft rejection after transplantation. The purpose of this study was to evaluate the relationship between tacrolimus pharmacokinetics and excess fluid distribution according to pre-transplant dialysis modality.


We retrospectively analyzed 41 adult living-donor kidney transplantations, including nine PD patients and 32 hemodialysis (HD) patients. We examined tacrolimus pharmacokinetics in the peri-operative period and determined the association between the tacrolimus absorption rate and body weight reduction. The absorption efficacy of tacrolimus was evaluated as the dose-normalized tacrolimus absorption rate. Tacrolimus concentrations in PD effluent were measured by high-performance liquid chromatography.


The tacrolimus absorption rate on the day before kidney transplantation tended to be lower in PD patients than in HD patients; however, the rate improved after kidney transplantation and was similar in both groups of patients. The peak tacrolimus concentration time was later in PD patients than in HD patients. The body weight reduction after kidney transplantation was greater in PD patients than in HD patients, and was significantly associated with the change in tacrolimus absorption rate (p = 0.04, r = 0.32). Only 0.002 % of the oral tacrolimus dose was removed by PD itself.


Excess fluid distribution in PD patients appears to contribute to tacrolimus malabsorption rather than PD itself. We should consider the risk of tacrolimus malabsorption in patients with possible excess fluid distribution, particularly in PD patients.


Peritoneal dialysis Excess fluid distribution Tacrolimus pharmacokinetics Living-donor kidney transplantation 


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Copyright information

© Japanese Society of Nephrology 2012

Authors and Affiliations

  • Tadashi Sofue
    • 1
  • Masashi Inui
    • 2
  • Hideyasu Kiyomoto
    • 3
  • Kumiko Moriwaki
    • 1
  • Taiga Hara
    • 1
  • Kazunori Yamaguchi
    • 4
  • Noriyasu Fukuoka
    • 4
  • Kazuko Banno
    • 5
  • Akira Nishiyama
    • 6
  • Yoshiyuki Kakehi
    • 2
  • Masakazu Kohno
    • 1
  1. 1.Division of Nephrology and Dialysis, Department of Cardiorenal and Cerebrovascular Medicine, Faculty of MedicineKagawa UniversityKagawaJapan
  2. 2.Department of Urology, Faculty of MedicineKagawa UniversityKagawaJapan
  3. 3.Division of Nephrology, Endocrinology and Vascular Medicine, Department of MedicineTohoku University Graduate School of MedicineSendaiJapan
  4. 4.Department of PharmacyKagawa University HospitalKagawaJapan
  5. 5.Shiga Pharmaceutical Association Proof CenterKusatsuJapan
  6. 6.Department of Pharmacology, Faculty of MedicineKagawa UniversityKagawaJapan

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