Calcium Channel Blockers in Kidney Transplant Recipients: Cyclosporine-Era Kidney-Function Effects and Tacrolimus Pharmacokinetic Implications: A Meta-Analysis
DOI:
https://doi.org/10.37275/bsm.v10i9.1656Keywords:
Calcium channel blockers, Cyclosporine, Kidney transplantation, Post-transplant hypertension, TacrolimusAbstract
Background: Post-transplant hypertension and calcineurin-inhibitor nephrotoxicity threaten cardiovascular and graft outcomes after kidney transplantation. Calcium channel blockers offer haemodynamic benefit and alter calcineurin-inhibitor exposure, but cyclosporine and tacrolimus studies assessed different evidence domains.
Objective: To pool the comparative effect of calcium channel blockers on kidney-function outcomes in adult kidney transplant recipients, and to distinguish the cyclosporine-era kidney-function evidence from the tacrolimus-era pharmacokinetic implications.
Methods: Comparative randomised trials and cohorts in adult kidney transplant recipients were identified through PubMed, the Cochrane Library, citation pathways, and reference checking. Kidney-function outcomes were directionally harmonised. Compatible standardised mean differences were pooled using a restricted maximum-likelihood random-effects model with Hartung–Knapp inference. Prediction intervals, subgroup analyses, influence diagnostics, sensitivity analyses, and Cochrane RoB 2 assessments were completed.
Results: At least 22 reports represented at least 21 independent datasets; seven cyclosporine-treated trials with 639 participants supplied compatible kidney-function data. Calcium channel blockers were favoured (Hedges g 0.38, 95% CI 0.11 to 0.66; I²=45.2%; τ²=0.042), although the 95% prediction interval ranged from −0.19 to 0.96. Leave-one-out estimates ranged from 0.26 to 0.45. DerSimonian–Laird and critical-risk sensitivities yielded g 0.38 and 0.37. A tacrolimus clinical subgroup and primary Egger test were not estimable.
Conclusion: Calcium channel blockers were associated with modestly better kidney-function measurements during cyclosporine treatment, but very-low-certainty evidence precluded a uniform benefit claim. Tacrolimus evidence instead concerned CYP3A5-dependent exposure and dose sparing; the two evidence streams remain clinically linked but quantitatively non-equivalent.
Authors
- Harnavi Harun1*
- Evelin Veronike1
- Garri Prima Decroli1
- Muhammad Ridhwan Fatharanifurqan2
- 1Nephrology Division, Department of Uronephrology, Faculty of Medicine, Universitas Andalas/Dr. M. Djamil General Hospital, Padang, Indonesia
- 2Nephrology Division, Department of Internal Medicine, Mentawai Islands Regional Hospital, Mentawai, Indonesia
Corresponding author Harnavi Harun — harnavi@med.unand.ac.id
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Copyright (c) 2026 Harnavi Harun, Evelin Veronike, Garri Prima Decroli, Muhammad Ridhwan Fatharanifurqan
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