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dose adjustment in renal failure

David K Packham, Ian R Fraser, Peter G Kerr, Karen R Segal
BACKGROUND: Diabetic nephropathy is the most common cause of end stage renal failure. We assessed the safety, tolerability, and explored therapeutic effects of adult allogeneic bone-marrow derived mesenchymal precursor cells (MPC) in patients with moderate to severe diabetic nephropathy. METHODS: Multicenter, randomized, double-blind, dose-escalating, sequential, placebo-controlled trial assessing a single intravenous (IV) infusion of allogeneic MPC (United States adopted name: rexlemestrocel-L) 150×10(6) (n=10), 300×10(6) (n=10) or placebo (n=10) in adults with diabetic nephropathy with an estimated glomerular filtration rate (eGFR) 20-50ml/min/1...
September 17, 2016: EBioMedicine
Rostislav Horacek, Barbora Krnacova, Jan Prasko, Klara Latalova
BACKGROUND: The aim of this study was to examine the impact of somatic illnesses, electrolyte imbalance, red blood cell count, hypotension, and antipsychotic and opioid treatment on the duration of delirium in Central Intensive Care Unit for Surgery. PATIENTS AND METHODS: Patients who were admitted to the Department of Central Intensive Care Unit for Surgery in the University Hospital Olomouc from February 2004 to November 2008 were evaluated using Riker sedation-agitation scale...
2016: Neuropsychiatric Disease and Treatment
Atsuko Tanaka, Ikuko Yano, Keiko Shinsako, Eriko Sato, Masahide Fukudo, Satohiro Masuda, Toshinari Yamasaki, Tomomi Kamba, Osamu Ogawa, Kazuo Matsubara
BACKGROUND: Everolimus has been used for the treatment of unresectable or metastatic renal cell carcinoma (RCC). Here, we measured blood concentrations of everolimus to obtain the population pharmacokinetic parameters and to examine the relationship between blood concentration and clinical outcomes. METHODS: Twenty-two Japanese patients were enrolled. Blood samples were collected before and 2, 4, 8, and 24 h after drug administration on days 1 and 8 of everolimus therapy (5 or 10 mg) for inpatients; occasional samples were collected for outpatients...
September 19, 2016: Therapeutic Drug Monitoring
Barbara A Konkle
In some clinical settings laboratory measurement of direct oral anticoagulants effect is helpful in guiding medical care, such as life-threatening bleeding, need for emergency surgery, renal impairment, severe hepatic failure, extremes of body weight, or in patients with bleeding or thrombosis on therapy. This article reviews approaches to laboratory testing to assess the anticoagulant effect of these drugs. Because of the wide variation in levels measured in patients on therapy and minimal clinical data from dose adjustment, dose adjustment based on levels is not currently advised...
October 2016: Hematology/oncology Clinics of North America
Nathaniel M Hawkins, Pardeep S Jhund, Andrea Pozzi, Eileen O'Meara, Scott D Solomon, Christopher B Granger, Salim Yusuf, Marc A Pfeffer, Karl Swedberg, Mark C Petrie, Sean Virani, John J V McMurray
AIMS: The non-vitamin K antagonist oral anticoagulants (NOACs) have varying degrees of renal elimination which may be challenging in patients with heart failure (HF) and atrial fibrillation (AF). We examined the severity and variation in renal impairment, and the proportion of patients requiring NOAC cessation or dose reduction. METHODS AND RESULTS: A retrospective analysis of patients with HF and AF in the Candesartan in Heart failure Assessment of Reduction in Mortality and Morbidity programme was carried out...
September 2016: European Journal of Heart Failure
Luis Sargento, Andre Vicente Simões, Susana Longo, Nuno Lousada, Roberto Palma Dos Reis
BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) is a disease of older people, but the target doses of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) are unknown. OBJECTIVE: To evaluate the association of ACEI/ARB dose level with long-term survival in stable older patients (aged >70 years) and octogenarian outpatients with HFrEF. POPULATION AND METHODS: A total of 138 outpatients aged >70 years (35...
September 2016: Drugs & Aging
Rohan Shah, Manesh R Patel
BACKGROUND: The safety and efficacy of the oral anticoagulant rivaroxaban were studied in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF trial). A number of subanalyses of the ROCKET AF trial have subsequently analyzed the use of rivaroxaban in special patient populations. METHODS: The outcomes of the ROCKET AF trial were reviewed. The use of rivaroxaban in higher risk populations, as determined by the presence of co-morbidities included in the CHADS2 criteria, was analyzed...
August 23, 2016: Therapeutic Advances in Cardiovascular Disease
Vladimir Tesar, Zdenka Hruskova
BACKGROUND: Lupus nephritis (LN) is still associated with significant mortality and substantial risk of progression to end-stage renal failure. Its outcome is related to the class and severity of LN and response to treatment, and it is poorer in patients with renal relapses. Ethnicity has a relatively well-defined impact on the outcome of the patients and their response to treatment and must always be taken into consideration in treatment decisions. SUMMARY: In this article, we provide a review of the impact of ethnicity on the prevalence of systemic lupus erythematosus (SLE), the proportion of patients with SLE developing LN, outcomes of SLE and LN and response of LN to treatment...
September 2015: Kidney Diseases
Sylvain Barreau, Sihem Benaboud, Solen Kernéis, Laurence Moachon, Philippe Blanche, Matthieu Groh, Laurent Massias, Jean-Marc Treluyer, Claire Poyart, Josette Raymond
We report two cases of treatment failure in patients with osteoarticular infection associated with <i>Staphylococcus aureus</i> bacteremia and receiving daptomycin. Using a published population-pharmacokinetic model and daptomycin blood level in these patients, area under the curve (AUC) was calculated and compared to the pharmacological target. For the first patient, treated with 6 mg/kg every 48 hours due to acute renal failure and then every 24 hours, the AUC was 820 mg×h×L<sup>-1</sup>, with a minimal concentration of 23...
November 2016: International Journal of Clinical Pharmacology and Therapeutics
Markus J Barten, Uwe Schulz, Andres Beiras-Fernandez, Michael Berchtold-Herz, Udo Boeken, Jens Garbade, Stephan Hirt, Manfred Richter, Arjang Ruhpawar, Jan Dieter Schmitto, Felix Schönrath, Rene Schramm, Martin Schweiger, Markus Wilhelm, Andreas Zuckermann
There is currently no consensus regarding the dose or duration of rabbit antithymocyte globulin (rATG) induction in different types of heart transplant patients, or the timing and intensity of initial calcineurin inhibitor (CNI) therapy in rATG-treated individuals. Based on limited data and personal experience, the authors propose an approach to rATG dosing and initial CNI administration. Usually rATG is initiated immediately after exclusion of primary graft failure, although intraoperative initiation may be appropriate in specific cases...
June 2016: Transplantation Direct
Yi-Chih Hung, Che-Chen Lin, Wei-Lun Huang, Man-Ping Chang, Ching-Chu Chen
The incidence of heart failure hospitalization (HHF) after taking sitagliptin in type 2 diabetes (T2DM) patients with end stage renal disease (ESRD) on dialysis is unclear. In this population-based cohort study, we identified individuals with T2DM and ESRD on dialysis who were treated with sitagliptin between 2009 and 2011 and randomly selected a control cohort matched by age, sex, duration of T2DM, hypertension medications, use of statin and aspirin, sulfonylureas, glinides, and insulin usage, atherosclerotic heart disease, congestive heart failure and chronic obstructive pulmonary disease at a 1:4 ratio...
2016: Scientific Reports
R Lenssen, A Liekweg
Many geriatric patients with multimorbidities have an increased risk for impaired renal function due to age and often the presence of comorbidities, such as diabetes mellitus, hypertension and heart failure. This impairment in kidney function in turn necessitates adjustments in drug therapy. A successful strategy for treating these patients includes treatment of the underlying diseases, a comprehensive review of the indications, selection of appropriate pharmacotherapeutic alternatives and for some drugs dose adjustment to the renal function...
August 2016: Zeitschrift Für Gerontologie und Geriatrie
Emma Aitken, Gillian McColl, David Kingsmore
OBJECTIVE: Current treatment strategies for painful critical ischemia in patients with end-stage renal disease (ESRD) are suboptimal. A drug that is non-renally excreted has minimal systemic absorption and does not require dose adjustment in renal failure is attractive. The aim of this study was to evaluate the safety and efficacy of Qutenza® (topical capsaicin 8%) for chronic neuropathic pain from critical ischemia in patients with ESRD. DESIGN AND SETTING: A prospective cohort study was conducted in a single-center, university teaching hospital...
July 14, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Teerapat Yingchoncharoen, Christine Jellis, Zoran B Popovic, Lu Wang, Neville Gai, Wayne C Levy, W H Wilson Tang, Scott Flamm, Deborah H Kwon
BACKGROUND: Prognostic value of myocardial fibrosis in patients with non-ischemic idiopathic dilated cardiomyopathy (DCM) is not well-defined. We sought to assess the association of focal and diffuse myocardial fibrosis with left ventricular reversed remodeling (LVRR). METHODS: Patients with DCM who underwent cardiac MRI with baseline and subsequent follow-up echocardiography were included in the study. Post-contrast T1 times were corrected for renal function, body size, gadolinium dose and time after Gadolinium injection...
October 15, 2016: International Journal of Cardiology
Mitsuyoshi Nakatani, Mitsuhiro Tsukino, Ryosuke Takahashi, Akio Ikeda
An 81-year-old woman suffering from sarcoidosis, chronic renal failure caused by hypertention was treated by valacyclovir 500 mg/day, for the diagnosis of herpes zoster of her right back. Her consciousness gradually became worse, and 3 days after taking the drug, she was sent to the emergency department of the hospital. Her conscious level was E2V2M5 (Glasgow Coma Scale) and myoclonus especially in her lower extremities occurred. Head CT and MRI show no obvious, acute abnormal findings other than chronic ischemic lesions, while an electroencephalogram (EEG) shows periodic synchronous discharges (PSDs) and disorganized background activity...
July 28, 2016: Rinshō Shinkeigaku, Clinical Neurology
Thomas A Schwann, Joseph R Habib, Jawad M Khalifeh, Victor Nauffal, Mark Bonnell, Christopher Clancy, Milo C Engoren, Robert H Habib
BACKGROUND: Red blood cell transfusion after coronary artery bypass graft surgery has been associated with increased late all-cause death. Yet, whether this association is, first, independent of the packed red blood cells and perioperative morbidity association, and second, of a cardiac versus noncardiac etiology remains unknown. METHODS: We analyzed patients undergoing coronary artery bypass graft surgery at two Ohio hospitals (n = 6,947) from 1994 to 2007. Salvage operations and patients with preoperative renal failure were excluded...
August 2016: Annals of Thoracic Surgery
Jasvinder A Singh, Shaohua Yu
OBJECTIVE: To assess the effect of allopurinol dose/duration on the risk of renal failure in the elderly with allopurinol use. METHODS: We used the 5% random Medicare claims data from 2006 to 2012. Multivariable-adjusted Cox regression analyses assessed the association of allopurinol dose/duration with subsequent risk of developing incident renal failure or end-stage renal disease (ESRD) (no prior diagnosis in last 183 days) in allopurinol users, controlling for age, sex, race and Charlson-Romano comorbidity index...
June 13, 2016: Annals of the Rheumatic Diseases
L Zhu, T Ding, X X Wang, Z B Lin, G Chen
OBJECTIVE: To assess the effectiveness and safety of the conversion therapy from traditional cyclosporine (CsA) triple immunosuppression therapy to sirolimus (SRL) combined with low dose CsA and prednisone (Pred) in renal transplantation recipients in a five-year follow-up period. METHODS: A prospective, open-label non-randomized study was performed with 46 renal allograft recipients who visited Tongji Hospital regularly for follow-up visits between January 2007 and May 2011 and were taking CsA+ mycophenolate mofetil (MMF)+ Pred...
May 31, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Prasert Thanakitcharu, Boonthum Jirajan
BACKGROUND: Erythropoiesis-stimulating agent (ESA) treatment is the optimal therapy for anemia in end-stage renal disease (ESRD) patients receiving hemodialysis. During treatment with ESA, the level of hemoglobin usually fluctuates widely; this phenomenon is known as "hemoglobin cycling" and may be associated with higher rates of mortality. OBJECTIVE: To estimate the prevalence of hemoglobin cycling in Thai ESRD patients treated with chronic maintenance hemodialysis and ESA, to assess its clinical impact on patient outcomes, and to identify the associated risk factors for hemoglobin cycling occurrence...
February 2016: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Tomoyuki Uchida, Morihiro Inoue, Jian Hua, Masao Hagihara
A 63-year-old man with Bence Jones-κ multiple myeloma (MM) presented with renal impairment. First, we administered a bortezomib-containing regimen which is considered to be the first choice among therapeutic approaches for MM patients with renal failure. However, his condition was refractory to bortezomib, and the renal dysfunction worsened (creatinine 12.55mg/dl) necessitating the initiation of hemodialysis. Subsequently, we administered an adjusted dose of lenalidomide and dexamethasone. Dialysis could be discontinued after 3 cycles of lenalidomide therapy...
May 2016: [Rinshō Ketsueki] the Japanese Journal of Clinical Hematology
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