Nutrition in Kidney Disease by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030448585
Publisher: Springer International Publishing

Maintenance Therapy

Maintenance immunosuppression is essential to prevent rejection and to preserve long-term function of the allograft. Maintenance immunosuppression is a delicate balance with too much increasing the risk of infection or malignancy and too little leading to rejection and loss of graft. Most recipients receive triple therapy for maintenance immunosuppression, which includes a calcineurin inhibitor (CNI), a corticosteroid, and an antimetabolite [15].

Calcineurin Inhibitors

Calcineurin inhibitors inhibit the action of calcineurin, an enzyme that activates T-cells of the immune system, which play a key role in cell-mediated immunity. Tacrolimus remains the CNI of choice over cyclosporine as it is superior in improving graft survival and preventing acute rejection [1, 21]. Ironically, these drugs are nephrotoxic and can cause hypertension and hyperkalemia especially with high levels [22]. Hypophosphatemia and hypomagnesemia are also common findings after kidney transplantation due to CNI-induced urinary excretion of phosphate and magnesium [23]. Increased intake of foods high in phosphorous and magnesium may not be sufficient for repletion and often necessitates use of supplementation [23]. Both CNIs can cause hyperglycemia and gastrointestinal distress, but tacrolimus is associated with a higher incidence of posttransplant diabetes and gastrointestinal side effects [24, 25] .

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