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drug dosing in kidney failure

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https://www.readbyqxmd.com/read/27909438/donor-specific-regulatory-t-cells-acquired-from-tolerant-mice-bearing-cardiac-allograft-promote-mixed-chimerism-and-prolong-intestinal-allograft-survival
#1
Xiao-Fei Shen, Jin-Peng Jiang, Jian-Jun Yang, Wei-Zhong Wang, Wen-Xian Guan, Jun-Feng Du
The induction of donor-specific transplant tolerance has always been a central problem for small bowel transplantation (SBT), which is thought to be the best therapy for end-stage bowel failure. With the development of new tolerance-inducing strategies, mixed chimerism induced by co-stimulation blockade has become most potent for tolerance of allografts, such as skin, kidney, and heart. However, a lack of clinically available co-stimulation blockers has hindered efficient application in humans. Furthermore, unlike those for other types of solid organ transplantation, strategies to induce robust mixed chimerism for intestinal allografts have not been fully developed...
2016: Frontiers in Immunology
https://www.readbyqxmd.com/read/27884245/acute-kidney-injury-in-asians%C3%A2-with%C3%A2-atrial%C3%A2-fibrillation-treated%C3%A2-with%C3%A2-dabigatran%C3%A2-or-warfarin
#2
Yi-Hsin Chan, Yung-Hsin Yeh, Lai-Chu See, Chun-Li Wang, Shang-Hung Chang, Hsin-Fu Lee, Lung-Sheng Wu, Hui-Tzu Tu, Chi-Tai Kuo
BACKGROUND: Whether dabigatran is associated with a lower risk of acute kidney injury (AKI) in patients with nonvalvular atrial fibrillation (NVAF) remains unknown. OBJECTIVES: The authors compared the risk of AKI in Asians with NVAF who were prescribed dabigatran versus warfarin. METHODS: The authors analyzed patients enrolled in the Taiwan nationwide retrospective cohort study from June 1, 2012, to December 31, 2013. Dabigatran and warfarin were taken by 7,702 and 7,885 NVAF patients without a history of chronic kidney disease (CKD) and 2,256 and 2,089 NVAF patients with a history of CKD, respectively...
November 29, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27814935/diuretic-resistance
#3
Ewout J Hoorn, David H Ellison
Diuretic resistance is defined as a failure to achieve the therapeutically desired reduction in edema despite a full dose of diuretic. The causes of diuretic resistance include poor adherence to drug therapy or dietary sodium restriction, pharmacokinetic issues, and compensatory increases in sodium reabsorption in nephron sites that are not blocked by the diuretic. To illustrate the pathophysiology and management of diuretic resistance, we describe a patient with nephrotic syndrome. This patient presented with generalized pitting edema and weight gain despite the use of oral loop diuretics...
November 1, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27814401/the-kallikrein-kinin-system-a-novel-mediator-of-il-17-driven-anti-candida-immunity-in-the-kidney
#4
Kritika Ramani, Abhishek V Garg, Chetan V Jawale, Heather R Conti, Natasha Whibley, Edwin K Jackson, Sruti S Shiva, William Horne, Jay K Kolls, Sarah L Gaffen, Partha S Biswas
The incidence of life-threatening disseminated Candida albicans infections is increasing in hospitalized patients, with fatalities as high as 60%. Death from disseminated candidiasis in a significant percentage of cases is due to fungal invasion of the kidney, leading to renal failure. Treatment of candidiasis is hampered by drug toxicity, the emergence of antifungal drug resistance and lack of vaccines against fungal pathogens. IL-17 is a key mediator of defense against candidiasis. The underlying mechanisms of IL-17-mediated renal immunity have so far been assumed to occur solely through the regulation of antimicrobial mechanisms, particularly activation of neutrophils...
November 2016: PLoS Pathogens
https://www.readbyqxmd.com/read/27783256/predictive-factors-of-renal-toxicities-related-to-anti-vegfr-multikinase-inhibitors-in-phase-1-trials
#5
Emilie Boissier, Olivier Mir, Antoine Hollebecque, Hassan Izzedine, Stéphane Ederhy, Anas Gazzah, Rastislav Bahleda, Christophe Massard, Isabelle Macquin-Mavier, Christophe Tournigand, Jean-Philippe Spano, Jean-Charles Soria, Benoît Rousseau
Purpose Renal toxicities are common with angiogenesis multikinase inhibitors (AMKI), and can be limiting in phase I trials. Factors associated with such toxicities are poorly known. The aims of this exploratory study were to describe renovascular toxicities associated with AMKI, impact on drug development and to identify baseline parameters associated with the occurrence of renal toxicities in phase I trials. Methods Consecutive patients treated with AMKI in Gustave Roussy phase I unit between October 2005 and August 2013 were included...
October 25, 2016: Investigational New Drugs
https://www.readbyqxmd.com/read/27781419/low-dose-mycophenolate-mofetil-in-tablet-form-or-capsule-form-combined-with-tacrolimus-in-the-early-period-after-kidney-transplantation-a-prospective-randomized-trial%C3%A2
#6
Su Lee, Chan-Duck Kim, Kyu Huh, Baik-Hwan Cho, Man Ju, Dong Lee, Hong Cho, Jong-Won Park, Jung Lee, Samuel Lee, Byung So, Chang-Kwon Oh, Yu Kim
AIMS: The tablet form (500 mg) of mycophenolate mofetil (MMF) provides more convenience of taking drugs and cost-effectiveness than the capsule form (250 mg). We examined the efficacy and safety of MMF in its different forms combined with tacrolimus in kidney transplant recipients. METHODS: This multicenter, 26-week, randomized trial was performed to compare the efficacy and safety of the tablet form of MMF versus the capsule form of MMF in 156 kidney transplant recipients...
October 26, 2016: Clinical Nephrology
https://www.readbyqxmd.com/read/27775769/association-between-changes-in-cms-reimbursement-policy-and-drug-labels-for-erythrocyte-stimulating-agents-with-outcomes-for-older-patients-undergoing-hemodialysis-covered-by-fee-for-service-medicare
#7
Cunlin Wang, Robert Kane, Mark Levenson, Jeffrey Kelman, Michael Wernecke, Joo-Yeon Lee, Steven Kozlowski, Carmen Dekmezian, Zhiwei Zhang, Aliza Thompson, Kimberly Smith, Yu-Te Wu, Yuqin Wei, Yoganand Chillarige, Qin Ryan, Chris Worrall, Thomas E MaCurdy, David J Graham
Importance: In 2011, the US Centers for Medicare & Medicaid Services (CMS) changed its reimbursement policy for hemodialysis to a bundled comprehensive payment system that included the cost of erythrocyte-stimulating agents (ESAs). Also in 2011, the US Food and Drug Administration revised the drug label for ESAs, recommending more conservative dosing in patients with chronic kidney disease. In response to concerns that these measures could have adverse effects on patient care and outcomes, the CMS and the FDA initiated a collaboration to assess the effect...
December 1, 2016: JAMA Internal Medicine
https://www.readbyqxmd.com/read/27754015/br-04-1management-of-treatment-resistant-hypertension
#8
David John Webb
Treatment-resistant hypertension (TRH) is defined as the failure to achieve an office BP target of <140/90 mmHg (<130/80 mmHg in patients with chronic kidney disease (CKD) or diabetes) in patients with hypertension (HT), despite adherence to at least 3 antihypertensive medications at optimal tolerated doses, ideally including a diuretic (Calhoun et al., Circulation 2008). TRH identifies patients with hard-to-treat HT, who might benefit from specialist investigation and treatment. Although some studies put the prevalence of TRH as >10%, these levels may be inflated by white-coat hypertension and poor adherence...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754008/js-ish-esh-4-what-do-clinical-trials-teach-us-about-selection-of-antihypertensive-drugs
#9
William C Cushman
Beginning with the Veterans Administration (VA) Cooperative Hypertension Study of the 1960 s, blood pressure (BP) lowering with antihypertensive medications has been shown to reduce major cardiovascular (CV) outcomes, including coronary heart disease, stroke, heart failure (HF) and CV and all-cause mortality in randomized controlled CV outcome trials. Multiple drugs were usually required in these trials to lower BP in treated participants. Medication regimens in the early trials, including the VA trial, included a thiazide-type diuretic (TTD) as initial therapy...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27737531/a-prospective-observational-study-of-effectiveness-and-safety-of-iron-isomaltoside-in-patients-with-chronic-renal-failure-and-iron-deficiency-anemia%C3%A2
#10
Patrick Biggar, Frank Leistikow, Andreas Walper
AIMS: The aim of this study was to investigate the effectiveness, safety, and tolerability of iron isomaltoside in routine practical care of iron deficiency anemia (IDA) in patients with chronic renal failure. METHODS: The study included 698 patients with IDA on dialysis or with nondialysis chronic kidney disease (CKD) stages 3 - 5 designated by their physicians for treatment with iron isomaltoside. Data were recorded at baseline and after 3 and 9 months. Effectiveness data included measurement of hemoglobin (Hb), hematocrit, s-iron, transferrin saturation (TSAT), and s-ferritin...
October 14, 2016: Clinical Nephrology
https://www.readbyqxmd.com/read/27698722/analysis-of-the-first-therapeutic-target-achieving-time-of-warfarin-therapy-and-associated-factors-in-patients-with-pulmonary-embolism
#11
Xiaowei Gong, Haiyan Wang, Yadong Yuan
The present study aimed to investigate the factors affecting the first therapeutic-target-achieving (TTA) time of warfarin therapy in patients with acute pulmonary embolism (PTE). Between January 2008 and June 2013, patients with PTE confirmed by transpulmonary arterial enhanced computed tomographic pulmonary angiography or pulmonary ventilation perfusion scanning were included in the present study. Data collected included demographic information, history of tobacco and alcohol intake, basic diseases (stable and unstable hypertension, diabetes, heart failure, cancer/cerebral infarction, old myocardial infarction and atrial fibrillation), liver and kidney function, the haemoglobin and platelet count of the blood, international normalized ratio monitoring, warfarin dosage adjustment and medication combinations...
October 2016: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/27693178/cyclophosphamide-administration-routine-in-autoimmune-rheumatic-diseases-a-review
#12
Kaian Amorim Teles, Patrícia Medeiros-Souza, Francisco Aires Correa Lima, Bruno Gedeon de Araújo, Rodrigo Aires Correa Lima
Cyclophosphamide (CPM) is an alkylating agent widely used for the treatment of malignant neoplasia and which can be used in the treatment of multiple rheumatic diseases. Medication administration errors may lead to its reduced efficacy or increased drug toxicity. Many errors occur in the administration of injectable drugs. The present study aimed at structuring a routine for cyclophosphamide use, as well as creating a document with pharmacotherapeutic guidelines for the patient. The routine is schematized in three phases: pre-chemotherapy (pre-ChT), administration of cyclophosphamide, and post-chemotherapy (post-ChT), taking into account the drugs to be administered before and after cyclophosphamide in order to prevent adverse effects, including nausea and hemorrhagic cystitis...
September 17, 2016: Revista Brasileira de Reumatologia
https://www.readbyqxmd.com/read/27687200/hyperkalemia-in-heart-failure
#13
REVIEW
Chaudhry M S Sarwar, Lampros Papadimitriou, Bertram Pitt, Ileana Piña, Faiez Zannad, Stefan D Anker, Mihai Gheorghiade, Javed Butler
Disorders of potassium homeostasis can potentiate the already elevated risk of arrhythmia in heart failure. Heart failure patients have a high prevalence of chronic kidney disease, which further heightens the risk of hyperkalemia, especially when renin-angiotensin-aldosterone system inhibitors are used. Acute treatment for hyperkalemia may not be tolerated in the long term. Recent data for patiromer and sodium zirconium cyclosilicate, used to treat and prevent high serum potassium levels on a more chronic basis, have sparked interest in the treatment of hyperkalemia, as well as the potential use of renin-angiotensin-aldosterone system inhibitors in patients who were previously unable to take these drugs or tolerated only low doses...
October 4, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27642926/br-04-1management-of-treatment-resistant-hypertension
#14
David John Webb
Treatment-resistant hypertension (TRH) is defined as the failure to achieve an office BP target of <140/90 mmHg (<130/80 mmHg in patients with chronic kidney disease (CKD) or diabetes) in patients with hypertension (HT), despite adherence to at least 3 antihypertensive medications at optimal tolerated doses, ideally including a diuretic (Calhoun et al., Circulation 2008). TRH identifies patients with hard-to-treat HT, who might benefit from specialist investigation and treatment. Although some studies put the prevalence of TRH as >10%, these levels may be inflated by white-coat hypertension and poor adherence...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27642919/js-ish-esh-4-what-do-clinical-trials-teach-us-about-selection-of-antihypertensive-drugs
#15
William C Cushman
Beginning with the Veterans Administration (VA) Cooperative Hypertension Study of the 1960 s, blood pressure (BP) lowering with antihypertensive medications has been shown to reduce major cardiovascular (CV) outcomes, including coronary heart disease, stroke, heart failure (HF) and CV and all-cause mortality in randomized controlled CV outcome trials. Multiple drugs were usually required in these trials to lower BP in treated participants. Medication regimens in the early trials, including the VA trial, included a thiazide-type diuretic (TTD) as initial therapy...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27592119/diabetic-ketosis-during-hyperglycemic-crisis-is-associated-with-decreased-all-cause-mortality-in-patients-with-type-2-diabetes-mellitus
#16
Ivan Kruljac, Miroslav Ćaćić, Petra Ćaćić, Vedran Ostojić, Mario Štefanović, Aljoša Šikić, Milan Vrkljan
Patients with type 2 diabetes mellitus have impaired ketogenesis due to high serum insulin and low growth hormone levels. Evidence exists that ketone bodies might improve kidney and cardiac function. In theory, improved ketogenesis in diabetics may have positive effects. We aimed to assess the impact of diabetic ketosis on all-cause mortality in patients with type 2 diabetes mellitus presenting with hyperglycemic crisis. We analyzed 486 patients with diabetic ketosis and 486 age and sex-matched patients with non-ketotic hyperglycemia presenting to the emergency department...
September 3, 2016: Endocrine
https://www.readbyqxmd.com/read/27589851/renal-dysfunction-following-bone-marrow-transplantation
#17
Stephan Kemmner, Mareike Verbeek, Uwe Heemann
Acute kidney injury and long-term renal dysfunction are common problems following bone morrow transplantation (BMT) and highly related to mortality. The frequency and risk of renal dysfunction are directly related to the method of BMT, with myeloablative allogeneic BMT being associated to the highest risk followed by non-myeloablative allogeneic and myeloablative autologous BMT. The type of BMT is, thus, more important than co-factors such as advanced age, comorbidities, or high baseline serum creatinine. The causes for renal failure are multiple and include chemotherapy and high-dose radiation with fluid loss by diarrhea or vomiting, sepsis or nephrotoxic drugs such as calcineurin inhibitors and antimicrobials...
September 2, 2016: Journal of Nephrology
https://www.readbyqxmd.com/read/27584929/new-drugs-to-prevent-and-treat-hyperkalemia
#18
Laurence Lepage, Katherine Desforges, Jean-Philippe Lafrance
PURPOSE OF REVIEW: Hyperkalemia is frequent, but occurs mostly in patients with chronic kidney disease and is often the cause of discontinuation or omission of renin-angiotensin-aldosterone system inhibitors in patients with diabetes, chronic kidney disease and heart failure. RECENT FINDINGS: Without much evidence in the literature on its efficacy, sodium polystyrene sulfonate is being used frequently in the clinical setting to treat hyperkalemia. In the last few years, two new promising agents have been developed to treat hyperkalemia - patiromer and sodium zirconium cyclosilicate 9 (ZS-9)...
November 2016: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/27519420/metabolic-complete-response-with-vinflunine-as-second-line-therapy-in-a-kidney-transplanted-patient-with-advanced-urothelial-carcinoma-a-case-report
#19
Paola Bordi, Marcello Tiseo, Giorgio Baldari, Sebastiano Buti
BACKGROUND: Patients undergone kidney transplantation present higher risk of Urothelial Carcinoma (UC) development and represent a subgroup of special interest. To date, vinflunine is the only drug approved in Europe for the treatment of advanced UC after failure of platinum-based chemotherapy. However, to our knowledge, no data on the concomitant administration of vinflunine and immunosuppressive agents are available. CASE PRESENTATION: The patient, a 45 years old Caucasian male, presented poorly differentiated UC of the bladder recurred after initial cystectomy with abdominal lymphadenopathies evidenced by FDG-PET/CT...
2016: BMC Cancer
https://www.readbyqxmd.com/read/27494223/prevalence-and-implications-of-abnormal-laboratory-results-in-patients-in-the-terminal-phase-of-life
#20
Anniek D Masman, Dick Tibboel, Frans P M Baar, Monique van Dijk, Ron A A Mathot, Teun van Gelder
BACKGROUND: Pathophysiological changes at the end of life may affect pharmacokinetics of drugs. However, caregivers typically do not extensively monitor patients' laboratory parameters at the end of life. OBJECTIVE: Our aim was to describe laboratory parameters of hospice patients in the week before death. METHODS: A cohort study was conducted on available laboratory results in the week before death, including clinical chemistry and hematology tests...
August 2016: Journal of Palliative Medicine
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