Observational studyNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2024
Long-term renal and cardiovascular risks of tacrolimus in patients with lupus nephritis.
Observational study in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Myocardial injury in systemic lupus erythematosus and lupus nephritis: a silent threat.Clinical kidney journal · 2026Review
- Disease modification in lupus nephritis: towards a pathophysiology-based treatment paradigm.Nature reviews. Nephrology · 2026Review
- Safety profiles of calcineurin inhibitor-related infections in the pediatric population: a real-world pharmacovigilance analysis.European journal of pediatrics · 2026Article
- Proteomic Characterization of Replication Stress and Impaired Antioxidant Defense in Tacrolimus-Induced Chronic Nephrotoxicity.International journal of molecular sciences · 2026Article
- An exploration of markers of microvascular dysfunction in kidney transplant recipients randomized to belatacept: no clinical impact of CNIs on endothelial function.Frontiers in transplantation · 2026Article
- Metabolomics Analysis Uncovers Distinct Profiles of Liver Post-Transplant Patients by Immunosuppression Regimen.Metabolites · 2025Article
- Disease-Modifying Therapies in Lupus Nephritis: A Narrative Review Evaluating Currently Used Pharmacologic Agents.Rheumatology and therapy · 2025Review
- Tacrolimus or Mycophenolate Mofetil for Frequently Relapsing or Steroid-Dependent Nephrotic Syndrome: A Randomized Clinical Trial.JAMA pediatrics · 2025Article
- Article
- Nudging Nephrologists in Cardiovascular Risk Assessment and Management in Glomerular Diseases Treated with Immunosuppressants: An Implementation Study.Glomerular diseasesArticle
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
backgroundDespite continuous advancement, treatment of lupus nephritis (LN) remains challenging. Recent guidelines now include a regimen incorporating tacrolimus as a first-line treatment option. Even though tacrolimus is effective in combination with mycophenolate and corticosteroids, concerns remain regarding long-term use, given its association with increased cardiovascular risks including nephrotoxicity, hypertension, dyslipidemia and hyperglycemia in kidney transplant recipients. However, in LN, long-term evaluations and head-to-head comparisons are lacking and thus the safety profile remains ill-defined. We hypothesized that chronic toxicity also occurs in LN patients. Therefore, this study aimed to assess long-term cardiovascular and renal outcomes of tacrolimus in LN patients.
methodsThis observational cohort study examined adult LN patients treated with tacrolimus, assessing renal outcomes, hypertension, diabetes, dyslipidemia, cardiovascular events and the Framingham risk score. The results were compared with a control group of CNI-naïve LN patients.
resultsOf the 219 LN patients in this study, 43 (19.6%) had tacrolimus exposure. Over a median follow-up of 7.1 years, tacrolimus use was associated with significant kidney function decline (6.8 mL/min/1.73 m2, versus 0.8 in the control group). The incidence of end-stage kidney disease was similar. Cardiovascular event incidence was equally low in both groups. The 10-year risk of coronary heart disease was lower in the tacrolimus group, primarily due to age differences. HbA1c levels were higher in the tacrolimus group (37.4 mmol/mol) than in controls (33.6 mmol/mol), although the incidence of diabetes was similar. There were no differences in the occurrence of hypertension or dyslipidemia.
conclusionsOur study demonstrated that tacrolimus exposure was associated with long-term kidney function loss in LN patients. Although cardiovascular risk factors and events were similar to patients never exposed to tacrolimus, there may be an increased risk of developing diabetes. Therefore, our study supports vigilance towards renal adverse effects in LN patients treated with tacrolimus.
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