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renal dose adjustment

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https://www.readbyqxmd.com/read/29331401/preoperative-dipstick-albuminuria-and-other-urine-abnormalities-predict-acute-kidney-injury-and-patient-outcomes
#1
Sehoon Park, Soojin Lee, Anna Lee, Jin Hyuk Paek, Ho Jun Chin, Ki Young Na, Dong-Wan Chae, Sejoong Kim
BACKGROUND: It is unclear whether pathologic findings on preoperative urinalysis are associated with the risk of postoperative acute kidney injury (AKI). Therefore, we performed a retrospective review to investigate this association. METHODS: We assessed the clinical significance of preoperative dipstick urinalysis in a 10-year surgery cohort from a tertiary hospital in Korea. Patients without available information on perioperative serum creatinine levels or kidney injury prior to surgery were excluded...
January 10, 2018: Surgery
https://www.readbyqxmd.com/read/29330204/pazopanib-exposure-relationship-with-clinical-efficacy-and-safety-in-the-adjuvant-treatment-of-advanced-renal-cell-carcinoma
#2
Cora Sternberg, Frede Donskov, Naomi B Haas, Christian Doehn, Paul Russo, Mohamed A Elmeliegy, Guillaume Baneyx, Hiya Banerjee, Paola Aimone, Robert J Motzer
PURPOSE: PROTECT, a phase III randomized placebo-controlled study, evaluated pazopanib efficacy and safety in the adjuvant RCC setting. The relationship between pazopanib exposure (Ctrough) and efficacy and safety was evaluated. EXPERIMENTAL DESIGN: Evaluable steady-state blood trough concentrations were collected from 311 patients at week 3 or 5 (early Ctrough), and 250 patients at week 16 or 20 (late Ctrough). Pazopanib pharmacokinetic (PK) data was analyzed via a population model approach...
January 12, 2018: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
https://www.readbyqxmd.com/read/29319627/opioid-prescription-morbidity-and-mortality-in-us-transplant-recipients
#3
Kevin C Abbott, Chyng-Wen Fwu, Paul W Eggers, Anne W Eggers, Prudence P Kline, Paul L Kimmel
BACKGROUND: CDC guidelines recommend caution in prescribing opioids for chronic pain. The characteristics of opioid prescription (OpRx) among kidney transplant (KTx) recipients has not been described in a national population. METHODS: We assessed OpRx prevalence among prevalent KTx recipients, and associated duration (chronic, defined as ≥90 days in a year) and dosing (in morphine milligram equivalents per day, MME, of <50, 50-89, and ≥90) with outcomes, death and graft loss, among incident KTx recipients using 2006-2010 US Renal Data System files, including Medicare Part D for medication ascertainment...
January 10, 2018: Transplantation
https://www.readbyqxmd.com/read/29319234/comparative-pharmacokinetics-of-trandolapril-its-active-metabolite-and-verapamil-in-human-plasma-of-egyptian-population-using-hplc-ms-ms
#4
Ragaa Magdy, Ahmed H El-Khatib, Ahmed Hemdan, Omar Abd Elaziz, Maha Farouk, Michael W Linscheid
Trandolapril and verapamil are commonly used antihypertensive drugs. However, there is a lack of available data on the change of their pharmacokinetics in patients with liver or kidney impairment and hence the need for dose adjustment. In the presented work, a high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method was developed and validated for the monitoring of trandolapril, its active metabolite trandolaprilat, and verapamil in human plasma of patients with renal impairment and/or liver insufficiency...
January 10, 2018: Drug Testing and Analysis
https://www.readbyqxmd.com/read/29316564/primary-prevention-of-stroke-in-chronic-kidney-disease-patients-a-scientific-update
#5
Stefana Catalina Bilha, Alexandru Burlacu, Dimitrie Siriopol, Luminita Voroneanu, Adrian Covic
BACKGROUND: Although chronic kidney disease (CKD) is an independent risk factor for stroke, official recommendations for the primary prevention of stroke in CKD are generally lacking. SUMMARY: We searched PubMed and ISI Web of Science for randomised controlled trials, observational studies, reviews, meta-analyses and guidelines referring to measures of stroke prevention or to the treatment of stroke-associated risk factors (cardiovascular disease in general and atrial fibrillation (AF), arterial hypertension or carotid artery disease in particular) among the CKD population...
January 9, 2018: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29316186/organ-damage-changes-in-patients-with-resistant-hypertension-randomized-to-renal-denervation-or-spironolactone-the-denervhta-denervaci%C3%A3-n-en-hipertensi%C3%A3-n-arterial-study
#6
Anna Oliveras, Pedro Armario, Laia Sans, Albert Clarà, Susana Vázquez, Luis Molina, Júlia Pareja, Alejandro de la Sierra, Julio Pascual
Renal denervation and spironolactone have both been proposed for the treatment of resistant hypertension, but their effects on preclinical target organ damage have not been compared. Twenty-four patients with 24-hour systolic blood pressure ≥140 mm Hg despite receiving three or more full-dose antihypertensive drugs, one a diuretic, were randomized to receive spironolactone or renal denervation. Changes in 24-hour blood pressure, urine albumin excretion, arterial stiffness, carotid intima-media thickness, and left ventricular mass index were evaluated at 6 months...
January 5, 2018: Journal of Clinical Hypertension
https://www.readbyqxmd.com/read/29315849/continuous-intravenous-vancomycin-in-children-with-normal-renal-function-hospitalized-in-hematology-oncology-prospective-validation-of-a-dosing-regimen-optimizing-steady-state-concentration
#7
Delphine Hoegy, Sylvain Goutelle, Nathalie Garnier, Cécile Rénard, Cécile Faure-Conter, Christophe Bergeron, Yves Bertrand, Nathalie Bleyzac
Continuous intravenous (IV) infusion has been shown to be the best option to administer vancomycin because of its time-dependent bactericidal activity. Available IV vancomycin dosing guidelines in pediatrics with normal renal function leads to less than 50% of patients achieving a vancomycin serum concentration (Css) in the target range (15 to 20 mg/l). The primary objective of this study was to prospectively validate an age-based dosing regimen in pediatric onco-hematology. The secondary objective was to investigate the influence on Css attainment of different variables...
January 6, 2018: Fundamental & Clinical Pharmacology
https://www.readbyqxmd.com/read/29311094/pharmacokinetics-of-telavancin-at-fixed-doses-in-normal-body-weight-and-obese-classes-i-ii-and-iii-adult-subjects
#8
Kristen L Bunnell, Manjunath P Pai, Monica Sikka, Susan C Bleasdale, Eric Wenzler, Larry H Danziger, Keith A Rodvold
A recommended total body weight (TBW) dosing strategy for telavancin may not be optimal in obese patients. The primary objective of this study was to characterize and compare the pharmacokinetics (PK) of telavancin across four body size groups: normal to overweight and obesity classes I, II, and III. Healthy adult subjects (n=32) received a single, weight-stratified, fixed dose of 500 mg (n=4), 750 mg (n=8) or 1000 mg (n=20) of telavancin. Noncompartmental PK analyses revealed subjects with body mass index (BMI) ≥ 40 kg/m2 had a higher volume of distribution (16...
January 8, 2018: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/29311069/meropenem-vaborbactam-single-dose-pharmacokinetics-and-safety-in-subjects-with-chronic-renal-impairment
#9
Christopher M Rubino, Sujata M Bhavnani, Jeffery S Loutit, Brooke Lohse, Michael N Dudley, David C Griffith
Vaborbactam is a member of a new class of β-lactamase inhibitors with inhibitory activity against serine carbapenemases (e.g. Klebsiella pneumoniae carbapenemase) that has been developed in combination with meropenem. Pharmacokinetics of the combination were evaluated in 41 subjects with chronic renal impairment in a Phase 1, open-label, single-dose study. Subjects were assigned to one of five groups based on renal function: normal (creatinine clearance ≥90 mL/min), mild (estimated glomerular filtration rate [eGFR] 60-89 mL/min/1...
January 8, 2018: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/29310747/population-based-seroprevalence-of-puumala-hantavirus-in-finland-smoking-as-a-risk-factor
#10
F Latronico, S Mäki, H Rissanen, J Ollgren, O Lyytikäinen, O Vapalahti, J Sane
Puumala hantavirus (PUUV) causes hemorrhagic fever with renal syndrome in humans, that is an endemic disease in Finland. We estimated the seroprevalence of PUUV in Finland and explored risk factors and disease associations by using unique survey data with health register linkage. A total of 2000 sera from a nationwide health survey from 2011, representative of the adult population, were screened for PUUV IgG by immunofluorescence assay. We performed statistical analysis adjusting for stratified cluster design and taking into account sampling weights...
January 9, 2018: Epidemiology and Infection
https://www.readbyqxmd.com/read/29307101/aciclovir-induced-acute-kidney-injury-in-patients-with-suspected-viral-encephalitis-encountered-on-a-liaison-neurology-service
#11
Petya Bogdanova-Mihaylova, David Burke, John P O'Dwyer, David Bradley, Jennifer A Williams, Simon J Cronin, Shane Smyth, Raymond P Murphy, Sinead M Murphy, Catherine Wall, Dominick J H McCabe
BACKGROUND: Patients with 'suspected viral encephalitis' are frequently empirically treated with intravenous aciclovir. Increasing urea and creatinine are 'common', but rapidly progressive renal failure is reported to be 'very rare'. AIMS: To describe the clinical course and outcome of cases of aciclovir-induced acute kidney injury (AKI) encountered by the Liaison Neurology Service at AMNCH and to highlight the importance of surveillance and urgent treatment of this iatrogenic complication...
January 6, 2018: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/29305402/metformin-treatment-in-patients-with-type-2-diabetes-and-chronic-kidney-disease-stages-3a-3b-or-4
#12
Jean-Daniel Lalau, Farshad Kajbaf, Youssef Bennis, Anne-Sophie Hurtel-Lemaire, Frans Belpaire, Marc E De Broe
OBJECTIVE: This study was conducted to define a safe, effective dose regimen for metformin in moderate and severe chronic kidney disease (CKD; stages 3A/3B and 4, respectively), after the lifting of restrictions on metformin use in patients with diabetes with moderate-to-severe CKD in the absence of prospective safety and efficacy studies. RESEARCH DESIGN AND METHODS: Three complementary studies were performed: 1) a dose-finding study in CKD stages 1-5, in which blood metformin concentrations were evaluated during a 1-week period after each dose increase; 2) a 4-month metformin treatment study for validating the optimal metformin dose as a function of the CKD stage (3A, 3B, and 4), with blood metformin, lactate, and HbA1c concentrations monitored monthly; and 3) an assessment of pharmacokinetic parameters after the administration of a single dose of metformin in steady-state CKD3A, 3B, and 4...
January 5, 2018: Diabetes Care
https://www.readbyqxmd.com/read/29299983/metabolic-enzyme-system-and-transport-pathways-in-chronic-kidney-diseases
#13
Bin Liu, Fangmei Luo, Xiuju Luo, Shaobin Duan, Zhicheng Gong, Jie Peng
BACKGROUND: Chronic kidney disease (CKD), a global public health problem, affects numerous people worldwide, and the prevalence is rising. Results from animal experiments and clinical investigations have demonstrated that drug metabolic enzymes and transporters-mediated non-renal clearance is dramatically impaired in CKD, co-respondent with the alterations in the elimination of metabolized drugs. Accumulated uremic toxins may downregulate or directly inhibit the activity and/or the expression of drug metabolic enzymes and transporters, which may result in unintended alterations of drug exposure and response in cases when drugs dose are not adjusted for the renal dysfunction...
January 3, 2018: Current Drug Metabolism
https://www.readbyqxmd.com/read/29298646/tacrolimus-pharmacokinetic-considerations-for-clinicians
#14
Katharina Schutte-Nutgen, Gerold Tholking, Barbara Suwelack, Stefan Reuter
The calcineurin inhibitor tacrolimus (Tac) is an integral part of the standard immunosuppressive regimen after renal transplantation (RTx). However, clinical management of Tac therapy can be challenging because of its narrow therapeutic window and because many factors interfere with its metabolism. Therefore, therapeutic drug monitoring is used to adjust the dosage. Recently, we were able to classify patients receiving tacrolimus into two major metabolism groups by simple calculation of the C/D ratio (expressed as the blood concentration normalized by the dose)...
December 31, 2017: Current Drug Metabolism
https://www.readbyqxmd.com/read/29283448/pharmacokinetics-and-safety-of-momelotinib-in-subjects-with-hepatic-or-renal-impairment
#15
Yan Xin, Jun Kawashima, Winnie Weng, Ellen Kwan, Thomas Tarnowski, Jeffrey A Silverman
Momelotinib is a Janus kinase 1/2 inhibitor in clinical development for the treatment of myelofibrosis. Two phase 1 open-label, parallel-group, adaptive studies were conducted to evaluate the pharmacokinetics of a single 200-mg oral dose of momelotinib in subjects with hepatic or renal impairment compared with healthy matched control subjects with normal hepatic or renal function. Plasma pharmacokinetics of momelotinib and its major active metabolite, M21, were evaluated, and geometric least-squares mean ratios (GMRs) and associated 90% confidence intervals (CIs) for impaired versus each control group were calculated for plasma exposures (area under concentration-time curve from time 0 to ∞ [AUC∞ ] and maximum concentration) of momelotinib and M21...
December 28, 2017: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29283068/influence-of-genetic-polymorphisms-on-mycophenolic-acid-pharmacokinetics-and-patient-outcomes-in-renal-transplantation
#16
Miao Guo, Zi-Jie Wang, Hai-Wei Yang, Ling Meng, Ruo-Yun Tan, Min Gu, Ji-Fu Wei
Mycophenolic acid (MPA) is an immunosuppressive drug widely used in the treatment of organ transplantation and autoimmune diseases. Pharmacokinetics and pharmacodynamics of MPA varies between individuals, the potential reasons being the genetic polymorphisms in key enzymes, drug transporters and target proteins of MPA, involving uridine diphosphate glucuronosyltransferase enzymes, organic anion transport polypeptides, multidrug resistance-associated protein 2, inosine monophosphate dehydrogenase and others...
December 27, 2017: Current Drug Metabolism
https://www.readbyqxmd.com/read/29251785/delafloxacin-pharmacokinetics-in-subjects-with-varying-degrees-of-renal-function
#17
Randall K Hoover, Harry Alcorn, Laura Lawrence, Susan K Paulson, Megan Quintas, Sue K Cammarata
Delafloxacin, a fluoroquinolone, has activity against gram-positive organisms including methicillin-resistant Staphylococcus aureus and fluoroquinolone-susceptible and -resistant gram-negative organisms. This study was conducted to determine delafloxacin pharmacokinetics after a single intravenous infusion or oral dose administration in subjects with varying degrees of renal function. The study was an open-label, parallel-group crossover study in subjects with normal renal function or with mild, moderate, or severe renal impairment...
December 18, 2017: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29246708/prescription-of-dpp-4-inhibitors-to-type-2-diabetes-mellitus-patients-with-renal-impairment-a-uk-primary-care-experience
#18
Dionysis Spanopoulos, Brendan Barrett, Michael Busse, Toni Roman, Chris Poole
Members of the dipeptidyl peptidase-4 inhibitor drug class are indicated for glycemic control in patients with type 2 diabetes mellitus and all, except linagliptin, require dose adjustment in renal impairment. A cross-sectional analysis of a cohort of type 2 diabetes mellitus patients treated with dipeptidyl peptidase-4 inhibitors identified in the Clinical Practice Research Datalink was conducted to explore compliance with the renal adjustment requirements of the Summaries of Product Characteristics. Approximately one third of type 2 diabetes mellitus patients with creatinine clearance <50 mL/min who were at risk of inappropriate prescribing, were initiated on a DPP-4 inhibitor at a higher dose than the specified in their respective Summary of Product Characteristics...
December 12, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/29242093/efficacy-and-safety-of-chemotherapy-in-older-versus-non-older-patients-with-advanced-gastric-cancer-a-real-world-data-non-inferiority-analysis
#19
Laura Visa, Paula Jiménez-Fonseca, Elena Asensio Martínez, Raquel Hernández, Ana Custodio, Marcelo Garrido, Antonio Viudez, Elvira Buxo, Isabel Echavarria, Juana María Cano, Ismael Macias, Montserrat Mangas, Eva Martínez de Castro, Teresa García, Felipe Álvarez Manceñido, Ana Fernández Montes, Aitor Azkarate, Federico Longo, Asunción Díaz Serrano, Carlos López, Alicia Hurtado, Paula Cerdá, Raquel Serrano, Aitziber Gil-Negrete, Alfonso Martín Carnicero, Paola Pimentel, Avinash Ramchandani, Alberto Carmona-Bayonas
OBJECTIVE: Advanced gastric cancer (AGC) is a common neoplasm in older adults. Nevertheless, there are few specific management data in the literature. The aim of this study was to assess non-inferiority of survival and efficacy-related outcomes of chemotherapy used in older vs non-older patients with AGC. MATERIALS AND METHODS: We recruited 1485 patients from the AGAMENON registry of AGC treated with polychemotherapy between 2008-2017. A statistical analysis was conducted to prove non-inferiority for overall survival (OS) associated with the use of chemotherapy schedules in individuals ≥70 vs...
December 11, 2017: Journal of Geriatric Oncology
https://www.readbyqxmd.com/read/29241210/combination-cyclophosphamide-glucocorticoids-provide-better-tolerability-and-outcomes-versus-glucocorticoids-alone-in-patients-with-sjogren-s-associated-chronic-interstitial-nephritis
#20
Yuqi Shen, Jingyuan Xie, Li Lin, Xiao Li, Pingyan Shen, Xiaoxia Pan, Hong Ren, Nan Chen
BACKGROUND: Steroid therapy has become an effective option for patients with primary Sjogren's syndrome with tubulointerstitial nephritis (TIN), while the use of cytotoxic agents is still debated. Our study aimed to compare the clinical outcomes of patients treated with cyclophosphamide (CTX) combined with glucocorticoids with those of patients treated with glucocorticoids alone. METHODS: All patients with primary Sjogren's syndrome with chronic TIN admitted to the Division of Nephrology, Ruijin Hospital, from January 1, 2002, to April 30, 2016, and treated with steroids alone or combined with CTX were included...
2017: American Journal of Nephrology
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