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

S. R. Ali, I. Shaheen, D. Young, I. Ramage, H. Maxwell, D. A. Hughes, D. Athavale, M. G. Shaikh

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

LanguageEnglish
JournalPediatric Transplantation
Early online date18 Jan 2018
DOIs
Publication statusE-pub ahead of print - 18 Jan 2018

Fingerprint

Fludrocortisone
Transplants
Pediatrics
Transplantation
Nephrology
Sodium
Kidney Transplantation
Sodium bicarbonate
Blood pressure
Sodium chloride
Unit
Kidney
Sodium Bicarbonate
Blood Pressure
Sodium Chloride
Potassium
Therapeutics
Range of data
Hyperkalemia
Hyponatremia

Keywords

  • bicarbonate
  • chloride
  • fludrocortisone
  • paediatrics
  • renal replacement therapy
  • renal transplantation
  • tubulopathy
  • sodium

Cite this

Ali, S. R. ; Shaheen, I. ; Young, D. ; Ramage, I. ; Maxwell, H. ; Hughes, D. A. ; Athavale, D. ; Shaikh, M. G. / Fludrocortisone-a treatment for tubulopathy post-paediatric renal transplantation : a national paediatric nephrology unit experience. In: Pediatric Transplantation. 2018.
@article{75e78e5dd82d46f0a359ece39090d1ed,
title = "Fludrocortisone-a treatment for tubulopathy post-paediatric renal transplantation: a national paediatric nephrology unit experience",
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.",
keywords = "bicarbonate, chloride, fludrocortisone, paediatrics, renal replacement therapy, renal transplantation, tubulopathy, sodium",
author = "Ali, {S. R.} and I. Shaheen and D. Young and I. Ramage and H. Maxwell and Hughes, {D. A.} and D. Athavale and Shaikh, {M. G.}",
note = "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.",
year = "2018",
month = "1",
day = "18",
doi = "10.1111/petr.13134",
language = "English",
journal = "Pediatric Transplantation",
issn = "1397-3142",

}

Fludrocortisone-a treatment for tubulopathy post-paediatric renal transplantation : a national paediatric nephrology unit experience. / Ali, S. R.; Shaheen, I.; Young, D.; Ramage, I.; Maxwell, H.; Hughes, D. A.; Athavale, D.; Shaikh, M. G.

In: Pediatric Transplantation, 18.01.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Fludrocortisone-a treatment for tubulopathy post-paediatric renal transplantation

T2 - Pediatric Transplantation

AU - Ali, S. R.

AU - Shaheen, I.

AU - Young, D.

AU - Ramage, I.

AU - Maxwell, H.

AU - Hughes, D. A.

AU - Athavale, D.

AU - Shaikh, M. G.

N1 - 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.

PY - 2018/1/18

Y1 - 2018/1/18

N2 - 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.

AB - 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.

KW - bicarbonate

KW - chloride

KW - fludrocortisone

KW - paediatrics

KW - renal replacement therapy

KW - renal transplantation

KW - tubulopathy

KW - sodium

U2 - 10.1111/petr.13134

DO - 10.1111/petr.13134

M3 - Article

JO - Pediatric Transplantation

JF - Pediatric Transplantation

SN - 1397-3142

ER -