Effect of Immunosuppressive Drugs on Kidney Function among Kidney Transplanted Patients in Gaza Strip

Abstract

Background: Immunosuppressive drugs (ISDs) are referred to agent that can suppress or prevent the immune response. ISDs are used to prevent rejection of a transplanted organ and to treat autoimmune diseases. A common side-effect of many ISDs is immunodeficiency, because the majority of them act non-selectively, resulting in increased susceptibility to infections and decreased cancer immuno surveillance. There are also other side-effects, such as hypertension, dyslipidemia, hyperglycemia, peptic ulcers, moon face, liver and kidney injury. Aim: To study effect of ISDs on kidney function among a group of kidney transplanted patients in Gaza Strip. Materials and methods: The experimental sample size was 65 patients aged over 18 from AL-shifa hospital who had gone on ISDs. The control sample was 65 healthy persons who had not gone on ISDs therapies before and matched the experimental sample in age, sex and residence. Data were obtained from questionnaire interview. About 6 ml blood were collected from each patient and random urine samples was collected from patients for the determination of microalbumin, the same samples were collected from controls. Results: The Patients who had taken Cyclosporine e were 72.3%, whereas patients who had taken tacrolimus were 27.7%. Patients above the normal level of Cyclosporine e were 87.2%. The main self repeated complications, blood pressure (BP), diabetes mellitus (DM), peptic ulcer and fever were 63.1%, 16.9%, 9.2% and 3.1% respectively. Body Mass Index (BMI) showed no statistical significant between different groups (X2=0.785, P=0.675), indicating that obesity is not a risk factor among the patients. Serum urea concentration was significantly increased in patients compared to controls (51.2±28.0 vs. 33.0± 6.4 mg/dl, p=0.000). Similar trend was found for uric acid (5.77±1.3 vs. 4.86±1.3 mg/dl, p=0.000). Also similar trend was found for creatinine (1.59±0.89 vs. 0.97±0.182 mg/dl, p=0.000). Sodium (Na) concentration was significantly decreased in patients compared to controls (138.07±4.34 vs. 140± 3.04 mEq/L, p=0.000). Similar trend was found for potassium (K) (4.07±0.48 vs. 4.24±0.45 mEq/L, p=0.040). There were no significant difference with chloride (Cl) concentration among patients and controls (95.67±13.19 vs. 96.83±3 mEq/L, p=0.499). Serum leptin was increased in patients compared to control mean (9.37±11.72 vs. 7.41±9.45 ng/ml, p=0.000). Serum microalbumin was highly increased in patient mean level compared to control mean (64.2±42.7 vs. 15.16±15.75 mg/dl, p=0.000). Glomerular filtration rate (GFR) was decreased in patient mean compared to control mean ± SD (57.53±18.90 vs. 86.36±14.78 mL/min/1.73 m2, p=0.000). The correlation test showed positive significant relation between leptin level and BMI (R=0.458, p=0.000). However no significant relation was found between leptin level and age and duration of transplantation (R=0.024, p=0.785 and R=0.100, p=0.430). The spearman test showed negative significant relation between leptin level and GFR (R=-0.223, p=0.011). Serum leptin was increased in females compared to males mean ± SD (15.6±12.6 vs. 5.18±7.75 ng/ml, p=0.000). Comparison between effect of Cyclosporine e and tacrolimus, points out that urea, uric acid, creatinin and microalbumin concentration were significantly increased in patients who had taken Cyclosporine e compared to patients who had taken tacrolimus (57.18, 5.99, 1.74 and 71.49 vs. 35.66, 5.99, 1.72 and 44.0 mg/dl) respectively (p=0.005, p=0.036, p=0.049 and p=0.017) respectively. And the mean of GFR were significantly decreased in patients who had taken Cyclosporine e compared to patients who had taken tacrolimus (t=-2.54, p=0.014).