Fludrocortisone-a treatment for tubulopathy post-paediatric renal transplantation : a national paediatric nephrology unit experience

Ali, S. R. and Shaheen, I. and Young, D. and Ramage, I. and Maxwell, H. and Hughes, D. A. and Athavale, D. and Shaikh, M. G. (2018) Fludrocortisone-a treatment for tubulopathy post-paediatric renal transplantation : a national paediatric nephrology unit experience. Pediatric Transplantation. ISSN 1399-3046 (https://doi.org/10.1111/petr.13134)

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Abstract

Calcineurin inhibitors post-renal transplantation are recognized to cause tubulopathies in the form of hyponatremia, hyperkalemia, and acidosis. Sodium supplementation may be required, increasing medication burden and potentially resulting in poor compliance. Fludrocortisone has been beneficial in addressing tubulopathies in adult studies, with limited paediatric data available. A retrospective review of data from an electronic renal database from December 2014 to January 2016 was carried out. Forty-seven post-transplant patients were reviewed with 23 (49%) patients on sodium chloride or bicarbonate. Nine patients, aged 8.3 years (range 4.9-16.4), commenced fludrocortisone 22 months (range 1-80) after transplant and were followed up for 9 months (range 2-20). All patients stopped sodium bicarbonate; all had a reduction or no increase in total daily doses of sodium chloride. Potassium levels were significantly lower on fludrocortisone, 5.2 vs 4.5 mmol/L, P = .04. No difference was noted in renal function (eGFR 77.8 vs 81.7 mL/min/1.73 m2 , P = .45) and no significant increase in systolic blood pressure (z-scores 0.99 vs 0.85, P = .92). No side effects secondary to treatment with fludrocortisone were reported. A significant proportion of renal transplant patients were on sodium supplementation and fludrocortisone reduced sodium supplementation without significant effects on renal function or blood pressure. Fludrocortisone appears to be safe and effective for tubulopathies in children post-transplantation.

  • Item type:Article
    ID code:62990
    Dates:
    Date
    Event
    18 January 2018
    Published
    18 January 2018
    Published Online
    21 December 2017
    Accepted
    Notes:This is the pre-peer reviewed version of the following article: Ali, S. R., Shaheen, I., Young, D., Ramage, I., Maxwell, H., Hughes, D. A., ... Shaikh, M. G. (2018). Fludrocortisone-a treatment for tubulopathy post-paediatric renal transplantation: A national paediatric nephrology unit experience. Pediatric Transplantation., which has been published in final form at https://doi.org/10.1111/petr.13134. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
    Subjects:Medicine > Pediatrics
    Science > Mathematics > Probabilities. Mathematical statistics
    Department:Faculty of Science > Mathematics and Statistics
    Depositing user: Pure Administrator
    Date deposited:23 Jan 2018 12:12
    Last modified:08 Apr 2024 23:49
    URI:https://strathprints.strath.ac.uk/id/eprint/62990
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