COMPARATIVE ANALYSIS OF ELECTROLYTE TRENDS AND BIOCHEMICAL PARAMETERS IN CHRONIC CALCINEURIN INHIBITOR TOXICITY AND T-CELL MEDIATED REJECTION IN RENAL TRANSPLANT PATIENTS

Introduction:

The kidney plays a vital role in maintaining the body’s electrolyte balance. Renal transplantation offers a lifeline to patients with end-stage renal disease, restoring their ability to regulate electrolytes effectively. Among the leading causes of allograft dysfunction are chronic calcineurin inhibitor (CNI) toxicity and allograft rejection. While CNIs are essential in preventing rejection, they can cause significant electrolyte disturbances. This study aims to analyze the changes in electrolyte trends over time, focusing on sodium (Na), potassium (K), and chloride (Cl), in patients suffering from chronic CNI toxicity compared to those experiencing T-cell mediated rejection (TCMR). Additionally, the study explores the broader impact of these conditions on other critical parameters such as urea, creatinine (Cr), urine protein-to-creatinine ratio (PCR), calcium (Ca), phosphorus (P), aspartate aminotransferase (AST), and alanine aminotransferase (ALT).

Methods:

This retrospective study screened renal biopsy reports of patients diagnosed with chronic CNI toxicity and TCMR from August 2022 to August 2024 at a tertiary hospital. Monthly laboratory reports were collected starting from two months prior to the biopsy, ensuring the availability of serum electrolyte values (Na, K, Cl), urea, creatinine, AST, ALT, and urine PCR for -2, -1, and 0 months from the date of biopsy. Calcium and phosphorus values were collected at the time of biopsy. The data were analyzed using repeated measures ANOVA and linear regression to delineate the differences in electrolyte profiles over time between the two groups. For calcium and phosphorus, independent t-tests were used to compare the values between the two groups at the time of biopsy.

Results:

A total of 31 biopsy reports were included, comprising 11 episodes of chronic CNI toxicity and 20 episodes of TCMR. The mean age of the patients was 31.6 ± 8.8 years in the CNI Toxicity group and 34.1 ± 10.8 years in the TCMR group. The repeated measures ANOVA showed a significant effect of time on sodium levels (p < 0.001). The interaction effect of Time*Biopsy was also significant (p = 0.029), indicating that the overall pattern of sodium level changes over time was significantly different between the groups. The slopes of urea trends were also significantly different (p = 0.038), indicating a different rate of change in urea levels over time between the two groups. For chloride, potassium, creatinine, urine PCR, AST, and ALT, the slopes were not significantly different (p = 0.265, p = 0.793, p = 0.743, p = 0.743, p = 0.512, and p = 0.612, respectively), suggesting similar rates of change in these parameters over time for both groups. Independent t-tests showed no significant differences in calcium and phosphorus levels between the two groups at the time of biopsy.

Conclusions:

The study found a significant difference in the slopes of sodium and urea trends between the CNI Toxicity and TCMR groups, suggesting that changes in sodium and urea levels over time can help differentiate between CNI toxicity and rejection.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.