Long-lasting renal dysfunction following tacrolimus induction therapy in ulcerative colitis patients

Although tacrolimus (TAC) has remarkable effects in ulcerative colitis (UC) patients when given as remission induction therapy, some can develop renal dysfunction during TAC administration, resulting in withdrawal, though related details remain poorly understood. This study was conducted to determine the impact of oral TAC on renal function for remission induction therapy in UC patients. Fifty-five patients (10 elderly, 45 non-elderly) with UC and treated with oral TAC at our hospital were retrospectively evaluated. Renal function was assessed using estimated glomerular filtration rate (eGFR). Although a high clinical response to TAC was seen in both elderly and non-elderly, a decline in eGFR was noted in nearly all patients regardless of age, with a maximum change of -34.4% from the baseline value at week 11. Furthermore, eGFR decline recovered quickly after TAC discontinuation, though did not return to the baseline at two years following cessation. The rate of eGFR change at week 12 was significantly associated with patient age (beta = -0.3242, p = 0.0103) and peak serum trough level during TAC treatment (beta = 0.3563, p = 0.0051). Furthermore, the rate of decline in eGFR was significantly greater during treatment with TAC in the elderly as compared to non-elderly, with a large difference in eGFR decline rate between those groups also noted at two years after withdrawal of treatment. Careful attention to renal function when administering oral TAC for UC is important and changes in eGFR should be monitored closely in elderly patients even after treatment cessation.

Automated summary

This study examined the impact of oral tacrolimus (TAC) on renal function in patients with ulcerative colitis (UC) undergoing remission induction therapy. The results showed that although TAC was effective in inducing remission in both elderly and non-elderly patients, a decline in estimated glomerular filtration rate (eGFR) was observed in almost all patients, with a maximum change of -34.4% from baseline at week 11. The decline in eGFR recovered quickly after TAC discontinuation, but did not return to baseline at two years following cessation of treatment. Age and peak serum trough level during TAC treatment significantly influenced the rate of eGFR change. Elderly patients experienced a greater decline in eGFR compared to non-elderly patients, and the difference in eGFR decline rate persisted at two years after treatment withdrawal. Therefore, careful monitoring of renal function and close attention to eGFR changes are important in UC patients receiving oral TAC, particularly in elderly patients after treatment cessation.