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Blood pressure changes induced by ciclosporin A in type I diabetes
T Hannedouche1, G Choukroun, A Delgado
1Département de Néphrologie, Hôpital Necker, Paris, France.
Insights
Ciclosporin A treatment in type 1 diabetics may increase blood pressure and renal vascular resistance. This study analyzed these effects over three months, noting mild changes in kidney function and blood pressure.
Area of Science:
- Nephrology
- Cardiology
- Immunology
Background:
- Ciclosporin A is a vital immunosuppressant, particularly in organ transplantation.
- Its use in type 1 diabetes (T1D) is less common, with potential cardiovascular and renal side effects needing further investigation.
- Understanding ciclosporin A's impact on blood pressure and renal function in T1D is crucial for patient management.
Purpose of the Study:
- To investigate the effects of chronic ciclosporin A treatment on blood pressure and renal hemodynamics in recent-onset type 1 diabetics.
- To assess the prevalence of hypertension in this cohort and compare it to organ transplant recipients.
- To explore the influence of a family history of essential hypertension on ciclosporin A's renal effects.
Main Methods:
- Analysis of blood pressure, glomerular filtration rate (GFR), renal plasma flow (RPF), filtration fraction (FF), and renal vascular resistance (RVR) at baseline and after 3 months of ciclosporin A treatment.
- Evaluation of absolute and fractional urinary sodium excretion.
- Stratification of patients based on family history of essential hypertension.
Main Results:
- Ciclosporin A treatment led to a mild average increase in blood pressure and a more pronounced increase in RVR.
- A slight decrease in GFR and RPF was observed, with FF remaining unchanged.
- The prevalence of hypertension was 17%, lower than reported in organ transplant populations.
- Patients with a family history of hypertension showed lower RPF, but this did not alter the renal effects of ciclosporin A.
Conclusions:
- Chronic ciclosporin A therapy in type 1 diabetics is associated with increased blood pressure and renal vascular resistance.
- Renal hemodynamics are mildly affected, with decreased GFR and RPF but stable FF.
- Family history of hypertension may indicate a predisposition to lower RPF but does not significantly modify ciclosporin A's renal impact in this cohort.
Abstract:
The determinants of ciclosporin A-induced blood pressure changes were analyzed initially and after 3 months in 30 recent type I diabetics submitted to chronic treatment with ciclosporin as single immunosuppressive drug. Prevalence of hypertension was 17% and relatively low as compared to those reported in organ transplantation. Ciclosporin induced a slight decrease in glomerular filtration rate and renal plasma flow, with unchanged filtration fraction, a mild average increase in blood pressure and a more pronounced increase in renal vascular resistance. There was a trend toward decrease in absolute urinary sodium excretion whereas fractional excretion of sodium was unchanged. Presence of familial history of essential hypertension was characterized by a slightly insignificantly lower renal plasma flow and did not affect the renal effect of ciclosporin except that the renal plasma flow was significantly lower in the groups of patients genetically predisposed.