Effect of renal function on the fluctuations in serum creatinine and potassium levels due to sulfamethoxazole-trimethoprim combination for preventing Pneumocystis pneumonia

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  • ニューモシスチス肺炎予防のST合剤による血清クレアチニン値およびカリウム値の変動に腎機能が及ぼす影響
  • ニューモシスチス ハイエン ヨボウ ノ STゴウザイ ニ ヨル ケッセイ クレアチニンチ オヨビ カリウムチ ノ ヘンドウ ニ ジンキノウ ガ オヨボス エイキョウ

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<p>The sulfamethoxazole-trimethoprim (ST) combination is the first choice as a prophylactic agent for Pneumocystis pneumonia. Although ST combination is known to inhibit the renal tubular transporters and increase serum creatinine (sCr) and potassium (K) levels, there is no information on the variations in these levels in patients with chronic kidney disease (CKD). The objective of this study was to clarify the criteria for the evaluation of adverse events by administering ST combination to patients with CKD, and to investigate the relationship between changes in sCr and sK levels and renal function at the start of administration. </p><p>Patients who received the ST combination from April 2016 to March 2018 were divided into the normal renal function group (eGFR ≥ 60 mL/min/1.73m2) [n=34], a moderate renal dysfunction group (30≦eGFR < 60 mL/min/1.73m2) [n=23], and the severe renal dysfunction group (eGFR < 30 mL/min/1.73m2) [n = 9]; the changes in sCr and sK levels were measured for each group from day 1 to day 14. The factors affecting the variations in sCr and sK levels were examined by simple and multiple regression analysis. </p><p>Although the ST combination significantly increased the levels of sCr and sK in the normal renal function group, there were no significant changes in the severe renal dysfunction group. The change in sCr level was positively affected by eGFR (mL/min/1.73m2) before administration, whereas the change in sK value was not affected. The value of eGFR (β=0.16), weekly dose of the ST combination (β=0.24) for changes in sCr levels, renal disease (β=0.20), and the renin-angiotensin-aldosterone inhibitor (β=0.23) were detected as significant factors for changes in sK levels. That is, the increase in sCr levels in patients with severe renal dysfunction was shown to be minimal. And, it should be noted that the degree of increase in both sCr and sK levels is affected not only by renal function, but also by the dose of ST combination, the underlying disease, and multiple factors of concomitant drugs.</p>

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