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Updated: Jul 22, 2026
Murine Renal Transplantation Procedure
Published on: July 10, 2009
Use of calcium-channel blockers in pediatric renal transplant recipients
D M Silverstein1, J Palmer, H J Baluarte
1Department of Pediatrics, St Christopher's Hospital for Children, Medical College of Pennsylvania/Hahnemann School of Medicine, Philadelphia, USA. DSilverst@aol.com
Insights
Calcium channel blockers effectively manage hypertension in pediatric kidney transplant recipients. While both nifedipine and amlodipine showed similar efficacy, amlodipine had fewer side effects, particularly gingival hyperplasia.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Transplantation
Background:
- Hypertension is a common complication in pediatric renal transplant recipients.
- Uncontrolled hypertension increases risks for cardiovascular disease and graft dysfunction.
Purpose of the Study:
- To compare the efficacy and adverse effects of nifedipine and amlodipine in pediatric renal transplant recipients with hypertension.
- To evaluate the impact of these calcium channel blockers on blood pressure control and graft function.
Main Methods:
- A cross-over study involving 24 pediatric renal transplant recipients with hypertension.
- Patients received either nifedipine or amlodipine, with no changes in other antihypertensive medications.
- Blood pressure, GFR, and adverse effects were monitored.
Main Results:
- Both nifedipine and amlodipine significantly reduced systolic and diastolic blood pressure.
- There was no significant difference in efficacy between nifedipine and amlodipine in blood pressure reduction.
- Patients reported a higher incidence of side effects with nifedipine, including gingival hyperplasia, which improved upon switching to amlodipine.
- Cyclosporine A levels and GFR remained stable and comparable between the two treatment groups.
Conclusions:
- Calcium channel blockers are effective for blood pressure control and renal protection in pediatric renal transplant recipients.
- Amlodipine may be preferred over nifedipine due to a lower incidence of adverse effects, particularly gingival hyperplasia.
Abstract:
Hypertension (HTN) is a significant problem in pediatric renal transplant (TP) recipients, predisposing the individuals to the development of cardiovascular disease and graft dysfunction. Calcium channel blockers (CCB) are considered excellent agents to treat post-TP HTN. We compared the efficacy and adverse effects of the two most commonly prescribed CCBs in our pediatric renal TP population: nifedipine (Procardia, or P) and amlodipine (Norvasc, or N). All patients (n = 24) had been started on a CCB for systolic (SBP) and/or diastolic BP (DBP) > 95%. There were no other changes in adjunctive antihypertensive medications or doses during the cross-over period. Post-TP, pretreatment (pretx) SBP was 137.6 +/- 10.9 mmHg. The post-treatment SBP were (in mmHg): 128.5 +/- 11.9 (all patients, n = 24) (p = 0.009 vs. pretx); 126.4 +/- 10.0 (P alone, n = 15) (p = 0.007 vs. pretx); 132.8 +/- 14.4 (P + other antihypertensive(s), n = 9) (p = 0.331, NS vs. pretx). The post-TP, pretreatment DBP was 88.2 +/- 11.1 mmHg. The post-treatment DBP were (in mmHg): 78.5 +/- 6.9 (all patients, n = 24) (p = 0.03 vs. pretx); 77.2 +/- 7.4 (P alone, n = 15) (p = 0.008 vs. pretx); 80.7 +/- 6.1 (P + other antihypertensive(s), n = 9) (p = 0.063, NS vs. pretx). P and N were equally effective in reducing SBP (p = 0.843, NS) and DBP (p = 0.612, NS). Cyclosporin A (CyA) dose (p = 0.81) and trough levels (p = 0.19) were similar in P- and N-treated patients. Calculated GFR was virtually identical in P- and N-treated patients (p = 0.89). Patients (or parents of) reported a higher incidence of various side-effects while receiving P, including headache, flushing, dizziness and leg cramps. Furthermore, 22/24 (91.7%) reported some degree of gingival hyperplasia during treatment with P, and all these patients reported a stabilization or reduction of hypertrophy after the switch from P to N. We conclude that CCBs (N) are efficacious drugs for the purpose of BP control and renal protection in pediatric renal TP recipients.
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