Nephrology Dialysis Transplantation, Vol 13, Issue 10 2612-2616, Copyright © 1998 by Oxford University Press
G Venkat-Raman, J Feehally, H Elliott, P Griffin, R Moore, J Olubodun and R Wilkinson
Background. Immunosuppressive treatment with
cyclosporin A (CsA) improves the survival of renal allografts, but is
associated with renal vasoconstriction and hypertension. Previous reports
suggest that the calcium-channel blockers nifedipine and amlodipine may
improve graft function in CsA-treated patients. We have compared the
effects of amlodipine (5-10 mg once daily) and nifedipine retard (10-40 mg
twice daily) on renal function and blood pressure in renal transplant
recipients treated with CsA. Methods. This was a
multicentre, two-way, crossover study in 27 evaluable hypertensive patients
with renal insufficiency following renal transplantation, who were
maintained on a stable dose of CsA. Patients received either amlodipine
(5-10 mg once daily) or nifedipine retard (10-40 mg twice daily) for 8
weeks, and were then crossed over to the other treatment for a further 8
weeks. Results. Trends were seen during amlodipine
treatment towards larger improvements, in serum creatinine (by 8% of
baseline on amlodipine vs 4% on nifedipine), lithium
clearance (13% vs 2%), and glomerular filtration rate
11% vs 7%). Effective renal plasma flow was increased
by 11% of baseline on nifedipine vs 9% on amlodipine.
There were no significant differences between treatments. Amlodipine and
nifedipine lowered systolic blood pressure to a similar extent (21 mmHg
vs 15 mmHg respectively, P=0.25),
but amlodipine was more effective than nifedipine in lowering diastolic
blood pressure (13 mmHg vs 8 mmHg,
P=0.006). Both treatments were well tolerated.
Conclusion. Once-daily amlodipine is at least
effective as twice-daily nifedipine retard in controlling blood pressure
and does not adversely affect graft function in hypertensive renal
allograft recipients. Keywords: amlodipine;
cyclosporin A; nifedipine; post-transplant hypertension; renal
transplantation
ORIGINAL ARTICLES
Renal and haemodynamic effects of amlodipine and nifedipine in hypertensive renal transplant recipients
St Mary's Hospital, Portsmouth, Hants PO3 6AD, UK; Leicester General Hospital, Leicester, UK; Western Infirmary, Glasgow, UK; Cardiff Royal Infirmary, Cardiff, UK; University Hospital of Wales, Cardiff, UK; Freeman Hospital, Newcastle upon Tyne, UK; Corresponding author
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  J. Chanard, O. Toupance, S. Lavaud, B. Hurault de Ligny, C. Bernaud, and B. Moulin Amlodipine reduces cyclosporin-induced hyperuricaemia in hypertensive renal transplant recipients Nephrol. Dial. Transplant., October 1, 2003; 18(10): 2147 - 2153. [Abstract] [Full Text] [PDF]
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