Trimethoprim/sulfamethoxazole and renal function in transplant patients

Abstract

Twenty-two patients with functioning renal allografts took part in a double-blind crossover trial during which placebo, sulfamethoxazole, and trimethoprim/sulfamethoxazole were given for periods of 14 days. The patients were divided into 2 groups. The first group consisting of 12 patients had serum creatinine levels less than 0.18 mmol/L and the second group of 10 patients had serum creatinine levels between 0.18 mmol/L and 0.35 mmol/L. Renal function at the end of each period was assessed by clearance of inulin (CIn), p-aminohippurate (CPAH) and endogenous creatinine (CCr). The second group also had a pitressin concentration test as a measure of distal tubule function. There was no change in inulin or creatinine clearance or in maximum concentration after pitressin in any of the patients in any of the phases. In the first group there was an increase in PAH clearance during the sulfonamide and trimethroprim/sulfamethoxazole phases. This change was not seen in the second group of patients with significantly impaired renal function.

Effect of Prophylactic Dose of Trimethoprim-Sulfamethoxazole on Serum Creatinine in Japanese Patients With Connective Tissue Diseases

“…With the usual dose of TMP/SMX, the TMP component inhibits tubular creatinine secretion, leading to a rapid but reversible increase in the SCr level [10][11][12][13][14][15][16] without altering the glomerular filtration rate. 17 The increase in the SCr level causes an apparent decrease in the calculated creatinine clearance.…”

“…Studies on the effect of TMP on SCr in healthy individuals have shown an average increase in the SCr level of 15% to 35%. [10][11][12][13][14][15][16] A study on TMP and its effect in patients with a 2 Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders normal renal function and those with chronic renal failure reported that the SCr level in patients with a normal renal function did not differ substantially from baseline levels, whereas that in patients with chronic renal failure elevated significantly from the baseline level. 12 In a previous study of outcomes in renal transplant recipients on TMP/SMX prophylaxis for 1 year, 38% of all patients suffered a complication necessitating cessation of TMP/SMX.…”