Effects of calcineurin inhibitors on sodium excretion in recipients of allogeneic hematopoietic stem cell transplantation

Abstract

Calcineurin inhibitors (CIs) such as cyclosporine A (CSA) and tacrolimus often cause renal dysfunction, resulting in increased serum creatinine, hyperkalemia, and hyperuricemia. However, the effects of CIs on sodium excretion have not been fully elucidated. We retrospectively evaluated the effects of CI administration on sodium excretion in recipients of allogeneic hematopoietic stem cell transplantation (HSCT). Fifty consecutive recipients each of allogeneic HSCT receiving either CSA or tacrolimus (100 patients in total) with available data for weekly fractional excretion of sodium (FENa) for a 4-week period after transplantation were enrolled in this retrospective analysis. No significant differences in patient characteristics were observed between CSA and tacrolimus groups except for the type of donor. FENa was significantly higher at the 3rd (1.25 ± 0.80) and 4th weeks (1.53 ± 1.06) after transplantation as compared with that at the 1st week (0.93 ± 0.51; P < 0.01, P < 0.001, respectively) in the tacrolimus group, but not at any time point in the CSA group. In addition, FENa was significantly higher in the tacrolimus group than the CSA group at the 4th week (1.53 ± 1.06 vs. 1.13 ± 0.80; P < 0.05). These results suggest that tacrolimus increases sodium excretion after allogeneic HSCT, and that this effect is minimal with CSA.

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Acknowledgements

The authors are indebted to Ms. Yuri Niizuma and Ms. Kaori Yanai for their skillful data management and Ms. Satomi Yamanaka for her excellent care of patients and their families.

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Correspondence to Takehiko Mori.

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Conflict of interest

TM received research funding from Novartis Pharma K.K. and honorarium from Astellas Pharma Inc; SO received research funding and honorarium from Novartis Pharma K.K. and Astellas Pharma Inc.

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Saburi, M., Kohashi, S., Kato, J. et al. Effects of calcineurin inhibitors on sodium excretion in recipients of allogeneic hematopoietic stem cell transplantation. Int J Hematol 106, 431–435 (2017). https://doi.org/10.1007/s12185-017-2253-x

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Keywords

  • Calcineurin inhibitor
  • Tacrolimus
  • Cyclosporine A
  • Sodium excretion
  • Allogeneic hematopoietic stem cell transplantation