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Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS
Published on: November 8, 2015
Vitamin B6 Insufficiency and Tacrolimus-Induced Tremors
Cihan Uysal1, Tugba Yilmaz, Merve Civan
1From the Department of Nephrology, Erciyes University Medical Faculty, Erciyes University, Kayseri, Turkey.
Objectives:
Tacrolimus-induced tremors were evaluated in relation to plasma pyridoxine status among kidney transplant recipients.
Materials And Methods:
Eligible patients were at least 6 months posttransplant with a functioning allograft, with the last 3 tacrolimus trough levels within target range. We analyzed 20 healthy volunteers solely for vitamin B6 status. Vitamin B6 insufficiency was defined as a pyridoxal-5'-phosphate level <7.5 μg/L (30 nmol/L). The tremor was detected by clinical examination and scored with the Essential Tremor Rating Assessment Scale.
Results:
We included 77 kidney transplant recipients (45.0 ± 12.4 years). Mean estimated glomerular filtration rate was 63.2 ± 22.0 mL/min/1.73 m². Mean tacrolimus trough level was 6.4 ± 2.0 ng/mL. Average pyridoxal-5'-phosphate level was 8.3 μg/L (IQR 6.6-10.0 μg/L) in kidney transplant recipients and 13.3 μg/L (IQR 11.4-16.9 μg/L) in healthy volunteers (P < .001). Vitamin B6 insufficiency was identified in 27 kidney transplant recipients (35.0%), whereas no cases were observed in volunteers. Tremor was observed in 45 kidney transplant recipients (58.4%). Tacrolimus trough levels did not significantly differ between patients with and without tremors. The pyridoxal-5'-phosphate level was 7.7 μg/L (IQR 6.3-9.2 μg/L) in recipients with tremors versus 9.0 μg/L (IQR 7.7-10.4 μg/L) in those without tremors (P = .035). Tremor frequency was significantly higher in recipients with vitamin B6 insufficiency versus those with sufficient vitamin B6 levels (77.8% vs 48.0%; P = .010). The Essential Tremor Rating Assessment Scale scores were not correlated with tacrolimus levels (P = .733) and pyridoxine concentrations (P = .322). Multivariate logistic regression analysis revealed that vitamin B6 insufficiency was an independent predictor for presence of tremor (P = .047). Vitamin B6 insufficiency was also associated with poorer outcomes in nerve conduction studies.
Conclusions:
Plasma pyridoxine was lower in kidney transplant recipients. Vitamin B6 insufficiency may be a facilitating factor for tacrolimus-induced tremors.
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