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renal dose adjustment

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https://www.readbyqxmd.com/read/28097012/pharmacokinetics-and-pharmacodynamics-of-antibiotics-in-critically-ill-acute-kidney-injury-patients
#1
REVIEW
Welder Zamoner, Fernanda M de Freitas, Durval S S Garms, Mariele Gobo de Oliveira, André L Balbi, Daniela Ponce
Sepsis is the most common cause of death in critically ill patients and is associated with multiorgan failure, including acute kidney injury (AKI). This situation can require acute renal support and increase mortality. Therefore, it is essential to administer antimicrobials in doses that achieve adequate serum levels, avoiding both overdosing and drug toxicity as well as underdosing and the risk of antibiotic resistance and higher mortality. Currently, there are no validated guidelines on antibiotic dose adjustments in septic patients with AKI...
December 2016: Pharmacology Research & Perspectives
https://www.readbyqxmd.com/read/28091757/-renal-protection-in-intensive-care-myths-and-facts
#2
S John
BACKGROUND: Acute kidney injury (AKI) is a common and severe complication in patients on the intensive care unit with a significant impact on patient mortality, morbidity and costs of care; therefore, renal protective therapy is most important in these severely ill patients. AIM OF THE REVIEW: Many renal protective strategies have been postulated during the last decades, which are sometimes still in place as a kind of "myth" but which are not always proven by evidence-based "facts"...
January 13, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28070716/pharmacokinetics-and-saturable-absorption-of-gabapentin-in-nursing-home-elderly-patients
#3
Ghada F Ahmed, Sai Praneeth R Bathena, Richard C Brundage, Ilo E Leppik, Jeannine M Conway, Janice B Schwartz, Angela K Birnbaum
Pharmacokinetic data of gabapentin (GBP) in community-dwelling elderly patients show a significant effect of advanced age on GBP pharmacokinetics due to altered renal function. However, there are no data in elderly nursing home (NH) patients to evaluate gabapentin absorption and elimination. Our objective was to characterize the pharmacokinetics of GBP in elderly nursing home patients maintained on GBP therapy. This was a prospective pharmacokinetic study in elderly nursing home patients (≥60 years) receiving GBP for the management of chronic pain or epilepsy from seven nursing homes...
January 9, 2017: AAPS Journal
https://www.readbyqxmd.com/read/28068177/safety-profile-of-nivolumab-monotherapy-a-pooled-analysis-of-patients-with-advanced-melanoma
#4
Jeffrey S Weber, F Stephen Hodi, Jedd D Wolchok, Suzanne L Topalian, Dirk Schadendorf, James Larkin, Mario Sznol, Georgina V Long, Hewei Li, Ian M Waxman, Joel Jiang, Caroline Robert
Purpose We conducted a retrospective analysis to assess the safety profile of nivolumab monotherapy in patients with advanced melanoma and describe the management of adverse events (AEs) using established safety guidelines. Patients and Methods Safety data were pooled from four studies, including two phase III trials, with patients who received nivolumab 3 mg/kg once every 2 weeks. We evaluated rate of treatment-related AEs, time to onset and resolution of select AEs (those with potential immunologic etiology), and impact of select AEs and suppressive immune-modulating agents (IMs) on antitumor efficacy...
November 14, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28057952/direct-thrombin-inhibitor-resistance-and-possible-mechanisms
#5
Maria Cardinale, Michael Ha, Michael H Liu, David P Reardon
Objective: To report 3 cases in which doses of bivalirudin higher than commonly used in clinical practice were required in order to achieve therapeutic anticoagulation as monitored by the activated partial thromboplastin time (aPTT). Case Summary: The medical records of 3 patients who required large doses of bivalirudin to remain therapeutic were thoroughly reviewed. In all 3 patients, bivalirudin was initiated at a rate appropriate for the patients' renal function and titrated using a nurse-driven protocol with recommended dose adjustments based on aPTT...
December 2016: Hospital Pharmacy
https://www.readbyqxmd.com/read/28056941/neutrophil-lymphocyte-ratio-as-a-predictive-biomarker-for-response-to-high-dose-interleukin-2-in-patients-with-renal-cell-carcinoma
#6
James A Kuzman, David D Stenehjem, Joseph Merriman, Archana M Agarwal, Shiven B Patel, Andrew W Hahn, Anitha Alex, Dan Albertson, David M Gill, Neeraj Agarwal
BACKGROUND: Immunotherapy with high-dose interleukin-2 (HD-IL2) results in long-term survival in some metastatic renal cell carcinoma (mRCC) patients but has significant acute toxicities. Biomarkers predicting response to therapy are needed to better select patients most likely to benefit. NLR (absolute neutrophil count (ANC)/absolute lymphocyte count (ALC)) is a prognostic and predicative biomarker in various malignancies. The goal was to determine whether NLR can predict response to HD-IL2 in this setting...
January 5, 2017: BMC Urology
https://www.readbyqxmd.com/read/28039098/efficacy-and-tolerability-of-interferon-free-antiviral-therapy-in-kidney-transplant-recipients-with-chronic-hepatitis-c
#7
Inmaculada Fernández, Raquel Muñoz-Gómez, Juan M Pascasio, Carme Baliellas, Natalia Polanco, Nuria Esforzado, Ana Arias, Martín Prieto, Lluis Castells, Valentín Cuervas-Mons, Olga Hernández, Javier Crespo, José L Calleja, Xavier Forns, María-Carlota Londoño
BACKGROUND AND AIMS: The development of direct-acting antivirals (DAAs) is a major step forward in the treatment of hepatitis C (HCV). The aims of the study were to evaluate the efficacy and tolerability of DAAs in kidney transplant (KT) recipients. METHODS: Hepa-C is a Spanish registry of patients treated with DAAs in which clinical, virological and analytical data were prospectively included. RESULTS: We report on the data from 103 KT recipients who received DAAs...
December 27, 2016: Journal of Hepatology
https://www.readbyqxmd.com/read/28035616/effects-of-renal-function-on-crizotinib-pharmacokinetics-dose-recommendations-for-patients-with-alk-positive-non-small-cell-lung-cancer
#8
Weiwei Tan, Shinji Yamazaki, Theodore R Johnson, Rong Wang, Melissa T O'Gorman, Leonid Kirkovsky, Tanya Boutros, Nicoletta M Brega, Akintunde Bello
BACKGROUND AND OBJECTIVES: Crizotinib (250 mg twice daily) is the first anaplastic lymphoma kinase (ALK) inhibitor approved for treatment of ALK-positive non-small-cell lung cancer (NSCLC). The objectives of the current study were to evaluate the effects of mild, moderate, and severe renal impairment on crizotinib pharmacokinetics and to make crizotinib dosing recommendations for ALK-positive NSCLC patients with renal impairment on the basis of the findings. METHODS: The effects of varying degrees of renal impairment on crizotinib pharmacokinetics were evaluated by: (1) analysis of mild and moderate renal impairment on multiple-dose pharmacokinetics of crizotinib in ALK-positive NSCLC patients from the PROFILE 1001 and PROFILE 1005 trials; (2) analysis of severe renal impairment on single-dose pharmacokinetics of crizotinib in volunteers (Study 1020); and (3) prediction of the effect of severe renal impairment on multiple-dose crizotinib pharmacokinetics using a physiologically-based pharmacokinetic model of crizotinib...
December 29, 2016: Clinical Drug Investigation
https://www.readbyqxmd.com/read/28035589/caspofungin-population-pharmacokinetics-in-critically-ill-patients-undergoing-continuous-veno-venous-haemofiltration-or-haemodiafiltration
#9
Claire Roger, Steven C Wallis, Laurent Muller, Gilbert Saissi, Jeffrey Lipman, Roger J Brüggemann, Jean-Yves Lefrant, Jason A Roberts
BACKGROUND AND OBJECTIVE: Sepsis and continuous renal replacement therapy (CRRT) can both significantly affect antifungal pharmacokinetics. This study aimed to describe the pharmacokinetics of caspofungin in critically ill patients during different CRRT modes. METHODS: Patients receiving caspofungin and undergoing continuous veno-venous haemofiltration (CVVH) or haemodiafiltration (CVVHDF) were eligible to take part in the study. Blood samples were collected at seven sampling times during a dosing interval...
December 29, 2016: Clinical Pharmacokinetics
https://www.readbyqxmd.com/read/28030534/single-nucleotide-polymorphism-of-cyp3a5-impacts-the-exposure-to-tacrolimus-in-pediatric-renal-transplant-recipients-a-pharmacogenetic-substudy-of-the-twist-trial
#10
Heiko Billing, Britta Höcker, Alexander Fichtner, Rita van Damme-Lombaerts, Styrbjorn Friman, Jenö Jaray, Karel Vondrak, Eniko Sarvary, Luca Dello Strologo, Michael Oellerich, Nicolas von Ahsen, Burkhard Tönshoff
BACKGROUND: The pharmacokinetics (PK) of tacrolimus (TAC) and mycophenolic acid (MPA) are highly variable. An impact of single-nucleotide polymorphisms (SNPs) of the genes coding for enzymes and transporters involved in the PK of TAC and/or MPA is intuitively conceivable. Accordingly, we sought to analyze the influence of different SNPs on TAC and MPA exposure in pediatric renal transplant recipients. METHODS: A subpopulation of 37 patients (median age: 12.8 years, range 2...
November 24, 2016: Therapeutic Drug Monitoring
https://www.readbyqxmd.com/read/28028830/retrospective-evaluation-of-postoperative-adverse-drug-events-in-patients-receiving-rivaroxaban-following-major-orthopedic-surgery-compared-to-standard-therapy-in-a-community-hospital
#11
Nicole E Cieri, Kristen Kusmierski, Cynthia Lackie, August Van Opdorp, Amany Hassan
STUDY OBJECTIVES: To evaluate the occurrence of bleeding and venous thromboembolic (VTE) events in patients receiving rivaroxaban, warfarin, or warfarin with the addition of enoxaparin during the immediate post-operative period following major orthopedic surgery. METHODS: Patients older than 18 years who received at least one dose of rivaroxaban the morning following surgery, adjusted dose warfarin, or adjusted dose warfarin with the addition of enoxaparin for VTE prophylaxis following major orthopedic surgery between October 1, 2011 and February 28, 2015 were included...
December 27, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/28025630/adjustment-of-eculizumab-dosage-pattern-in-patients-with-atypical-hemolytic-uremic-syndrome-with-suboptimal-response-to-standard-treatment-pattern
#12
Camino García Monteavaro, Carmen Peralta Roselló, Borja Quiroga, José María Baltar Martín, Lorena Castillo Eraso, Fernando de Álvaro Moreno, Alberto Martínez Vea, María Teresa Visus-Fernández de Manzanos
In patients with atypical hemolytic uremic syndrome (aHUS), complement blocking by eculizumab rapidly halts the process of thrombotic microangiopathy and it is associated with clear long-term hematologic and renal improvements. Eculizumab treatment consists of a 4-week initial phase with weekly IV administration of 900 mg doses, followed by a maintenance phase with a 1,200 mg dose in the fifth week and every 14 ± 2 days thereafter. We present three patients with aHUS and suboptimal response to eculizumab treatment at the usual administration dosage who showed hematologic and renal improvements after an adjustment in the eculizumab treatment protocol...
2016: Case Reports in Nephrology
https://www.readbyqxmd.com/read/28019010/pharmacokinetics-of-a-single-oral-dose-of-the-mek1-2-inhibitor-selumetinib-in-subjects-with-end-stage-renal-disease-or-varying-degrees-of-hepatic-impairment-compared-with-healthy-subjects
#13
Angela W Dymond, Paul Martin, Karen So, Yifan Huang, Paul Severin, Victoria Holmes, Gabriella Mariani, Thomas Marbury
Two phase I open-label studies were conducted to investigate the pharmacokinetics (PK), safety, and tolerability of single oral doses of selumetinib in subjects with end-stage renal disease (ESRD) undergoing hemodialysis and subjects with varying degrees of hepatic impairment; both studies included a matched control group comprised of healthy individuals. In the renal impairment study, subjects received single doses of selumetinib 50 mg; those with ESRD received selumetinib before and after dialysis (with a between-treatment washout period of ≥7 days)...
December 26, 2016: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28017584/feasibility-of-three-dimensional-magnetic-resonance-angiography-fluoroscopy-image-fusion-technique-in-guiding-complex-endovascular-aortic-procedures-in-patients-with-renal-insufficiency
#14
Adeline Schwein, Ponraj Chinnadurai, Dipan J Shah, Alan B Lumsden, Carlos F Bechara, Jean Bismuth
OBJECTIVE: Three-dimensional image fusion of preoperative computed tomography (CT) angiography with fluoroscopy using intraoperative noncontrast cone-beam CT (CBCT) has been shown to improve endovascular procedures by reducing procedure length, radiation dose, and contrast media volume. However, patients with a contraindication to CT angiography (renal insufficiency, iodinated contrast allergy) may not benefit from this image fusion technique. The primary objective of this study was to evaluate the feasibility of magnetic resonance angiography (MRA) and fluoroscopy image fusion using noncontrast CBCT as a guidance tool during complex endovascular aortic procedures, especially in patients with renal insufficiency...
December 23, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28013453/pk-pd-target-attainment-with-ceftolozane-tazobactam-using-monte-carlo-simulation-in-patients-with-various-degrees-of-renal-function-including-augmented-renal-clearance-and-end-stage-renal-disease
#15
Alan J Xiao, Luzelena Caro, Myra W Popejoy, Jennifer A Huntington, Ravina Kullar
INTRODUCTION: Ceftolozane/tazobactam is an antibacterial agent with potent in vitro activity against Gram-negative pathogens, including many extended-spectrum β-lactamase-producing Enterobacteriaceae and drug-resistant Pseudomonas aeruginosa. Because ceftolozane/tazobactam is primarily excreted renally, appropriate dose adjustments are needed for patients with renal impairment. Monte Carlo simulations were used to determine the probability of pharmacokinetic/pharmacodynamic target attainment for patients with varying degrees of renal function, including augmented renal clearance (ARC) and end-stage renal disease (ESRD) with hemodialysis...
December 24, 2016: Infectious Diseases and Therapy
https://www.readbyqxmd.com/read/28009722/safety-and-efficacy-of-under-dosing-non-vitamin-k-antagonist-oral-anticoagulants-in-patients-undergoing-catheter-ablation-for-atrial-fibrillation
#16
Hirosuke Yamaji, Takashi Murakami, Kazuyoshi Hina, Shunichi Higashiya, Hiroshi Kawamura, Masaaki Murakami, Shigeshi Kamikawa, Issei Komatsubara, Shozo Kusachi
BACKGROUND: Some patients with atrial fibrillation (AF) received under-doses of non-vitamin K antagonist oral anticoagulants (NOACs) in the real world. Under-dosing is defined as administration of a dose lower than the manufacturer recommended dose. OBJECTIVES: To identify the efficacy and safety of under-dosing NOACs as perioperative anticoagulation for AF ablation. METHODS: We retrospectively analyzed patients who received rivaroxaban or dabigatran etexilate according to dosage: adjusted low-dosage (reduced by disturbed renal function; n = 30), under-dosage (n = 307), or standard-dosage (n = 683)...
November 22, 2016: Journal of Cardiovascular Pharmacology
https://www.readbyqxmd.com/read/28004997/effect-of-long-term-low-dose-aspirin-therapy-on-renal-graft-function
#17
Hatem Ali, Ahmed Shaaban, Asam Murtaza, Laura E Howell, Aimun Ahmed
OBJECTIVES: Despite improvements in immunosuppressive protocols for renal transplant, long-term success of renal transplant is still limited by the occurrence of interstitial fibrosis and tubular atrophy. Some studies have shown that aspirin decreases the severity of kidney ischemia-reperfusion injury and the development of tubular atrophy in animal models. This study aimed to assess the effects of aspirin therapy started at the time of transplant on long-term graft function. MATERIALS AND METHODS: We compared renal graft function of 82 patients on low-dose aspirin 75 mg once daily who underwent renal transplant between 1 January 2000 and 31 December 2010 from a single center with 65 patients not taking aspirin...
December 22, 2016: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28002149/the-effect-of-allopurinol-on-renal-function
#18
Aneesa Krishnamurthy, Deana Lazaro, Dimitre G Stefanov, David Blumenthal, Donald Gerber, Sheetal Patel
BACKGROUND: Hyperuricemia is associated with development of gout, hypertension, and renal disease. The impact of allopurinol, a urate-lowering therapy, on renal function is unclear, especially in patients with chronic kidney disease who are at higher risk of hypersensitivity reaction. OBJECTIVES: The aim of this study was to determine the effect of allopurinol on kidney function in hyperuricemic male veterans. METHODS: This is a retrospective cohort study using pharmacy, medical, and laboratory records of veterans enrolled at the Veterans Administration New York Harbor Healthcare System, Brooklyn campus...
January 2017: Journal of Clinical Rheumatology: Practical Reports on Rheumatic & Musculoskeletal Diseases
https://www.readbyqxmd.com/read/27984331/safety-and-efficacy-of-under-dosing-non-vitamin-k-antagonist-oral-anticoagulants-in-patients-undergoing-catheter-ablation-for-atrial-fibrillation
#19
Hirosuke Yamaji, Takashi Murakami, Kazuyoshi Hina, Shunichi Higashiya, Hiroshi Kawamura, Masaaki Murakami, Shigeshi Kamikawa, Issei Komatsubara, Shozo Kusachi
BACKGROUND: Some patients with atrial fibrillation (AF) received under-doses of non-vitamin K antagonist oral anticoagulants (NOACs) in the real world. Under-dosing is defined as administration of a dose lower than the manufacturer recommended dose. OBJECTIVES: To identify the efficacy and safety of under-dosing NOACs as perioperative anticoagulation for AF ablation. METHODS: We retrospectively analyzed patients who received rivaroxaban or dabigatran etexilate according to dosage: adjusted low-dosage (reduced by disturbed renal function; n = 30), under-dosage (n = 307), or standard-dosage (n = 683)...
November 22, 2016: Journal of Cardiovascular Pharmacology
https://www.readbyqxmd.com/read/27977332/clinical-impact-of-the-cyp3a5-6986a-g-allelic-variant-on-kidney-transplantation-outcomes
#20
Adrien Flahault, Dany Anglicheau, Marie-Anne Loriot, Eric Thervet, Nicolas Pallet
AIM: Meta-analyses and large cohort studies provide confusing results on the association of the CYP3A5 6986A>G allelic variant and adverse outcomes in kidney transplant recipients under tacrolimus-based immunosuppressive regimen. A residual effect of CYP3A5 recipient genotype is unexpected if kidney transplant recipients have similar exposure of tacrolimus. PATIENTS & METHODS: We have undertaken a population-based, observational study, to investigate all the consecutive patients who received a kidney transplant at the Necker hospital between 2005 and 2015, who were treated with tacrolimus and for whom the CYP3A5 genotype was available...
January 2017: Pharmacogenomics
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