Vitamin B6 Insufficiency and Tacrolimus-Induced Tremors

Area of Science:

• Nephrology
• Pharmacology
• Neurology

Background:

• Tacrolimus is a crucial immunosuppressant after kidney transplantation.
• Tremors are a common side effect of tacrolimus therapy.
• The role of vitamin B6 (pyridoxine) in tacrolimus-induced tremors is not well understood.

Purpose of the Study:

• To investigate the relationship between plasma pyridoxine status and tacrolimus-induced tremors in kidney transplant recipients.
• To compare vitamin B6 levels in kidney transplant recipients with and without tremors.

Main Methods:

• Seventy-seven kidney transplant recipients with stable graft function and therapeutic tacrolimus levels were included.
• Plasma pyridoxal-5'-phosphate (PLP) levels were measured to assess vitamin B6 status.
• Tremors were clinically assessed using the Essential Tremor Rating Assessment Scale.
• A control group of 20 healthy volunteers was analyzed for vitamin B6 status.

Main Results:

• Kidney transplant recipients had significantly lower plasma pyridoxine levels compared to healthy volunteers (8.3 vs 13.3 μg/L).
• Vitamin B6 insufficiency (PLP <7.5 μg/L) was found in 35% of recipients.
• Tremors were observed in 58.4% of recipients and were more frequent in those with vitamin B6 insufficiency (77.8% vs 48.0%).
• Vitamin B6 insufficiency was an independent predictor of tremor presence.

Conclusions:

• Plasma pyridoxine levels are lower in kidney transplant recipients.
• Vitamin B6 insufficiency is common in this population and may contribute to tacrolimus-induced tremors.
• Supplementation with vitamin B6 may be a potential strategy to manage tremors in kidney transplant recipients.