Avaliação da monitorização terapêutica para acompanhamento da função renal em pacientes pós-transplante renal em uso de tacrolimo

Abstract

Kidney transplantation is the most performed type of transplantation in Brazil. Tacrolimus is one of the main drugs used in post-transplant immunosuppressive therapy and one of its main toxic effects is nephrotoxicity, requiring, therefore, adequate blood levels. Laboratory tests to evaluate renal function are very important in the follow-up of patients after kidney transplantation, helping in the diagnosis of events indicative of graft injury. This study aimed to evaluate the association between laboratory changes in renal function and blood levels of tacrolimus in post renal transplant patients. This was an observational, analytical and crosssectional study developed at Hospital Universitário Walter Cantídio (HUWC) from April to December 2022. The results of tacrolimus therapeutic monitoring tests and dosages of renal function biomarkers were analyzed, as well as the sociodemographic data of kidney transplant recipients, who underwent laboratory tests between January 2021 and July 2022 in the period close to 1 year after the transplantation date. The variables analyzed in the research were collected from the patients' medical records and further analyzed using IBM-SPSS v20 software. The study population was composed mostly of men, brown, with a mean age of 51.5 years and from cities in the countryside of the state of Ceará. The mean values of tacrolimus blood dosages, as well as the biomarkers of renal function evaluation analyzed, were slightly outside the reference values recommended for each variable. As for the percentage of patients who showed changes in the variables studied, 50.62% of them showed changes in tacrolimus blood levels, adding the percentages of patients above and below the stipulated therapeutic range, 56.79% showed changes in serum creatinine dosage, 49.48% showed changes in serum urea dosage, and 59.26% showed an altered eTFG. The correlation analyses performed suggested that there is no relationship between variations in tacrolimus blood concentrations and the appearance of changes in the results of classic biomarkers of renal function measured at the end of the first post-transplant year. The data obtained by this research provide subsidies for offering better care to patients after renal transplantation, but further studies are still necessary for a better understanding of the effect of tacrolimus on renal function in this group of patients.