{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T16:22:04Z","timestamp":1759335724827,"version":"3.41.2"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,11,24]],"date-time":"2022-11-24T00:00:00Z","timestamp":1669248000000},"content-version":"vor","delay-in-days":327,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatrics International"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Stabilizing blood levels with microemulsified cyclosporine A (CsA), administered in many pediatric kidney diseases, is important for effective immunosuppression and reduced nephrotoxicity. CsA is affected by total bile acids (TBAs); however, no reports have simultaneously measured both. We aimed to elucidate the hypothesized relationship between TBA levels and diurnal variation in CsA in children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively reviewed the medical records of children who were taking oral CsA for the treatment of kidney diseases between January 2016 and July 2021. They consumed four balanced meals and snacks during the day. CsA and TBA were measured twice, in pairs, before and at 0.5, 1, 1.5, 2, 3, and 4\u2009h after oral administration in the morning and evening, and the four\u2010h area under curve (AUC)<jats:sub>0\u20134<\/jats:sub> of CsA and trough\u2010to\u2010peak ratio (TPR) of TBA were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty\u2010eight pairs were measured in total; 12 children had idiopathic nephrotic syndrome and 4 children had immunoglobulin A vasculitis with nephritis. The median age at measurement was 7.5\u2009years and the dose of CsA was 3.8\u2009mg\/kg\/day. The AUC<jats:sub>0\u20134<\/jats:sub> (ng\u00b7h\/mL) was significantly lower in the evening than in the morning (1,669 vs. 1,451, <jats:italic>P<\/jats:italic> &lt;\u20090.001). The TPR of TBA was significantly higher in the evening than in the morning (0.14 vs. 0.25, <jats:italic>P<\/jats:italic> &lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The low AUC<jats:sub>0\u20134<\/jats:sub> and slow TBA secretion observed in the evening may be due to pediatric\u2010specific dietary rhythms; thus, snack timing should be considered in children for stabilizing CsA levels.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ped.15296","type":"journal-article","created":{"date-parts":[[2022,7,11]],"date-time":"2022-07-11T03:33:47Z","timestamp":1657510427000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effects of diurnal variation of bile acids by meal on cyclosporine A absorption"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4287-979X","authenticated-orcid":false,"given":"Tomohiko","family":"Nishino","sequence":"first","affiliation":[{"name":"Department of Pediatrics Teikyo University School of Medicine  Itabashi\u2010ku Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuhiro","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Teikyo University School of Medicine  Itabashi\u2010ku Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinya","family":"Tomori","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Teikyo University School of Medicine  Itabashi\u2010ku Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3771-5005","authenticated-orcid":false,"given":"Sayaka","family":"Ono","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Teikyo University School of Medicine  Itabashi\u2010ku Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masakazu","family":"Mimaki","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Teikyo University School of Medicine  Itabashi\u2010ku Tokyo 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