scholarly journals Efficacy of Low-Dose Dopamine in Preventing Amphotericin B Nephrotoxicity in Bone Marrow Transplant Patients and Leukemia Patients

1998 ◽  
Vol 42 (12) ◽  
pp. 3103-3106 ◽  
Author(s):  
Mary J. Camp ◽  
John R. Wingard ◽  
Claire E. Gilmore ◽  
Lillian S. Lin ◽  
Suzanne P. Dix ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Amphotericin B ◽  
Bone Marrow Transplant ◽  
Creatinine Level ◽  
Low Dose ◽  
Marrow Transplant ◽  
Drug Reactions ◽  
Baseline Serum

ABSTRACT This study evaluated the efficacy of low-dose dopamine for prevention of amphotericin B-induced nephrotoxicity in autologous bone marrow transplant and leukemia patients. Seventy-one patients undergoing cytoreductive therapy who required amphotericin B were randomly assigned in an unblinded fashion to a group receiving continuous-infusion low-dose dopamine (3 μg/kg/min) or a group receiving no dopamine. Amphotericin B was dosed at 0.5 or 1.0 mg/kg/day based on computerized tomography scan results or presence of positive blood cultures. No patient received saline boluses. The rate of nephrotoxicity, severity as graded by Southwest Oncology Group toxicity criteria, and time to each grade of nephrotoxicity were compared between the two groups. Eighty percent of the no-dopamine group and 66.7% of the dopamine group developed nephrotoxicity, defined as a 1.5-fold or greater increase in baseline serum creatinine level (P = 0.20). No statistical difference was noted at any grade of nephrotoxicity between the two groups. Thirty-four percent of patients in the no-dopamine group versus 17.6% in the dopamine group had a 2.5-fold or greater increase in serum creatinine level, which was not statistically significant (P = 0.0888). Ten patients developed grade IV nephrotoxicity and were withdrawn from the study, 7 in the no-dopamine group and 3 in the dopamine group (P = 0.19). The time to each grade of nephrotoxicity was also not significantly different for the two groups. Eleven adverse drug reactions were reported in the dopamine group in comparison to one in the no-dopamine group. Thus, dopamine offers little in the way of prevention of nephrotoxicity associated with amphotericin B therapy. Although the significance of drug reactions in the dopamine group is not clearly established due to lack of cardiac monitoring in the no-dopamine group, dopamine therapy is not without complications.

The prophylactic use of low-dose amphotericin B in bone marrow transplant patients

1994 ◽  
Vol 97 (6) ◽  
pp. 509-514 ◽  
Author(s):  
Deborah K. Riley ◽  
Andrew T. Pavia ◽  
Patrick G. Beatty ◽  
Finn B. Petersen ◽  
Joanne L. Spruance ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Amphotericin B ◽  
Bone Marrow Transplant ◽  
Low Dose ◽  
Marrow Transplant ◽  
Transplant Patients ◽  
Prophylactic Use

Effect of Infusion Rate on Amphotericin B-Associated Febrile Reactions

1988 ◽  
Vol 22 (10) ◽  
pp. 769-772 ◽  
Author(s):  
John D. Cleary ◽  
Daniel Weisdorf ◽  
Courtney V. Fletcher
Keyword(s):  
Bone Marrow ◽  
Amphotericin B ◽  
Bone Marrow Transplant ◽  
Cardiac Disease ◽  
Infusion Rate ◽  
Adverse Reactions ◽  
Fungal Infections ◽  
Marrow Transplant ◽  
Transplant Recipients ◽  
Axillary Temperature

Our objective was to prospectively study febrile and chill reactions associated with two amphotericin B (AB) infusion rates, slow (2-hour) versus rapid (45 minute). Seventeen consenting bone marrow transplant recipients in whom AB was to be initiated for documented or suspected fungal infections were recruited. After standardized premedication, patients received eight daily AB infusions (0.5 mg/kg/d, concentration 0.25 mg/ml). Rate was assigned using a randomized, crossover pair design. Axillary temperature, chills, and meperidine dose required to resolve chills were monitored for each infusion. For the first pair of infusions, fever (defined as a rise of 1 °C) occurred frequently, in 12 of 17 (70.5 percent) and 13 of 17 patients (76.4 percent), with a mean rise of 1.7 °C (range 1.1–3.7) and 1.7 °C (1.1–3.5) degrees for the 45-minute and 2-hour infusions, respectively (p > 0.10). Chills were observed in 15 of 17 (88.2 percent) and 14 of 17 (82.3 percent) recipients of the 45-minute and 2-hour infusions, respectively. The time of onset (p > 0.10) and the duration of chills (p = 0.08) were similar for both infusion rates. Meperidine requirements for rapid and slow infusions were similar as well (p = 0.12). These data suggest that for patients free of preexisting renal and cardiac disease, rapid AB infusions are well tolerated and produce adverse reactions (fever and chills) similar in nature and severity to slower infusions.

scholarly journals Effect of Fasting on Temporal Variation in the Nephrotoxicity of Amphotericin B in Rats

1999 ◽  
Vol 43 (3) ◽  
pp. 520-524 ◽  
Author(s):  
Michel LeBrun ◽  
Louis Grenier ◽  
Michel G. Bergeron ◽  
Louise Thibault ◽  
Gaston Labrecque ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Temporal Variation ◽  
Amphotericin B ◽  
Creatinine Level ◽  
Renal Toxicity ◽  
Intraperitoneal Administration ◽  
Control Group ◽  
Similar Data ◽  
Ad Libitum

ABSTRACT Evidence for temporal variation in the nephrotoxicity of amphotericin B was recently reported in experimental animals. The role of food in these variations was determined by studying the effect of a short fasting period on the temporal variation in the renal toxicity of amphotericin B. Twenty-eight normally fed and 28 fasted female Sprague-Dawley rats were used. Food was available ad libitum to the fed rats, while the fasted animals were fasted 12 h before and 24 h after amphotericin B injection to minimize stress for the animals. Water was available ad libitum to both groups of rats, which were maintained on a 14-h light, 10-h dark regimen (light on at 0600 h). Renal toxicity was determined by comparing the levels of excretion of renal enzyme and the serum creatinine and blood urea nitrogen (BUN) levels at the time of the maximal (0700 h) or the minimal (1900 h) nephrotoxicity after the intraperitoneal administration of a single dose of dextrose (5%; control group) or amphotericin B (50 mg/kg of body weight; treated group) to the rats. The nephrotoxicities obtained after amphotericin B administration at both times of day were compared to the nephrotoxicities observed for time-matched controls. In fed animals, the 24-h urinary excretion ofN-acetyl-β-d-glucosaminidase and β-galactosidase was significantly higher when amphotericin B was injected at 0700 and 1900 h. The excretion of these two enzymes was reduced significantly (P < 0.05) in fasting rats, and this effect was larger at 0700 h (P < 0.05) than at 1900 h. The serum creatinine level was also significantly higher (P < 0.05) in fed animals treated at 0700 h than in fed animals treated at 1900 h. Fasting reduced significantly (P < 0.05) the increase in the serum creatinine level, and this effect was larger in the animals treated at 0700 h. Similar data were obtained for BUN levels. Amphotericin B accumulation was significantly higher (P < 0.05) in the renal cortexes of fed rats than in those of fasted animals, but there was no difference according to the time of injection. These results demonstrated that fasting reduces the nephrotoxicity of amphotericin B and that food availability is of crucial importance in the temporal variation in the renal toxicity of amphotericin B in rats.

Risk of acute kidney injury associated with neuroimaging obtained during triage and treatment of patients with acute ischemic stroke symptoms

2016 ◽  
Vol 8 (12) ◽  
pp. 1231-1234 ◽  
Author(s):  
Shelby L Hall ◽  
Stephan A Munich ◽  
Marshall C Cress ◽  
Leonardo Rangel-Castilla ◽  
Elad I Levy ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Ischemic Stroke ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Acute Ischemic Stroke ◽  
Creatinine Level ◽  
Kidney Injury ◽  
Vascular Pathology ◽  
Baseline Serum ◽  
Iodinated Contrast

BackgroundCombining non-contrast CT (NCCT), CT angiography (CTA), and CT perfusion (CTP) imaging (referred to as a CT stroke study, CTSS) provides a rapid evaluation of the cerebrovascular axis during acute ischemic stroke. Iodinated contrast-enhanced CT imaging is not without risk, which includes renal injury. If a patient's CTSS identifies vascular pathology, digital subtraction angiography (DSA) is often performed within 24–48 h. Such patients may receive multiple administrations of iodinated contrast material over a short time period.ObjectiveWe aimed to evaluate the incidence of acute kidney injury (AKI) in patients who underwent a CTSS and DSA for evaluation of acute ischemic symptoms or for stroke intervention within a 48 h period between August 2012 and December 2014.MethodsWe identified 84 patients for inclusion in the analysis. Patients fell into one of two cohorts: AKI, defined as a rise in the serum creatinine level of ≥0.5 mg/dL from baseline, or non-AKI. Clinical parameters included pre- and post-imaging serum creatinine level, time between CTSS and DSA, and type of angiographic procedure (diagnostic vs intervention) performed.ResultsFour patients (4.7%) experienced AKI, one of whom had baseline renal dysfunction (defined as baseline serum creatinine level ≥1.5 mg/dL). The mean difference between baseline and peak creatinine values was found to be significantly greater in patients with AKI than in non-AKI patients (1.65 vs −0.09, respectively; p=0.0008).ConclusionsThis study provides preliminary evidence of the safety and feasibility of obtaining CTSS with additional DSA imaging, whether for diagnosis or intervention, to identify possible acute ischemic stroke.

Return to primary service among bone marrow transplant rehabilitation inpatients: An index for predicting outcomes.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19509-e19509
Author(s):  
Jack Brian Fu ◽  
Jay Ted Lee ◽  
Dennis Wesley Smith
Keyword(s):  
Bone Marrow ◽  
Platelet Count ◽  
Bone Marrow Transplant ◽  
Creatinine Level ◽  
Antibacterial Agent ◽  
Inpatient Rehabilitation ◽  
Marrow Transplant ◽  
Rehabilitation Unit ◽  
Transplant Patients ◽  
Primary Service

e19509 Background: Inpatient rehabilitation bone marrow transplant patients can be challenging due to their medical fragility. Methods: One hundred forty-seven bone marrow transplant patients admitted to inpatient rehabilitation at a major national cancer hospital between January 1, 2002, and April 15, 2009, regardless of the patient’s primary cancer were retrospectively studied. Return to primary service and factors including age, gender, race, presence of graft-versus-host disease, type of hematopoietic stem cell transplant, type of primary cancer, white blood cell count upon rehabilitation admission, platelet count, albumin level, prealbumin level, creatinine level, and presence of antimicrobial agents were analyzed. Results: Forty-one percent (61/147) of bone marrow transplant patients were transferred from the inpatient rehabilitation unit back to the primary service. Of those transferred back, 38% died after being transferred back to the primary service; 53%, 36%, and 39% of leukemia, lymphoma, and multiple myeloma transplant patients were transferred back to the primary service, respectively. No breast, germinoma, renal, testicular, or Waldenstrom macroglobulinemia patients were transferred back to primary service. Significant relationships were found with a platelet count < 43 (p<.01), a creatinine level > 0.9 (p<.05), the presence of an antibacterial agent (p<.05), the presence of an antifungal agent (p<.05) and leukemia, lymphoma or multiple myeloma type (p<.05). Using these 4 of these factors the Fu index was formulated to determine the likelihood of return to the primary team. Conclusions: Bone marrow transplant patients have a high rate of transfer from the inpatient rehabilitation unit back to the primary service and many of them eventually died while in the hospital. A low platelet count, a high creatinine level, the presence of an antibacterial agent, and the presence of an antifungal agent significantly increased the risk of return to primary. Close follow-up by the primary team while on the inpatient rehabilitation unit is recommended.

scholarly journals Impact of Baseline Admission Serum Creatinine Level in ST Segment Elevated Myocardial Infarction (STEMI) Patient Undergoing Primary PCI: An Important Predictor of in-hospital and 12-month Survival Outcome

2020 ◽  
Vol 12 (2) ◽  
pp. 135-142
Author(s):  
AHM Waliul Islam ◽  
Shams Munwar ◽  
Shahabuddin Talukder ◽  
AQM Reza ◽  
Azfar H Bhuiyan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Stemi Patient ◽  
Important Predictor ◽  
Primary Pci ◽  
Baseline Serum ◽  
Group A ◽  
Group B

Background: Several studies has shown that impaired renal function might be an important predictor of adverse cardiovascular events in patient with ST elevated myocardial Infarction (STEMI) undergoing primary percutaneous intervention (pPCI). Exact data on clinical impact of baseline or admission serum creatinine level of STEMI patient undergoing pPCI in our patient population not well established. Therefore, we have carried out this non-randomized study to see the effects of S. creatinine level on major adverse cardiovascular outcomes among STEMI patient undergoing pPCI. Methods: Patients were enrolled in this observational non-randomized prospective cohort between November 2017-July 2019, who were presented into our emergency department with acute onset of severe chest pain or angina with ECG evidenced of acute ST elevated myocardial infarction. Total 137 patient (F 12; Male 125) were enrolled in this study. Results: Out of 137 patients, female :12 (8.75%) vs Male: 125 (91.2%). Among, these patient females were more obese (BMI: Female 27.0 ± 2.2 vs male 25.4 ± 4.9) and developed CAD in advance age (Female 59.1 ± 14.5 vs Male 53.4 ± 10.5). Among the 137 patients, 89 (65%) were dyslipidemia, 72 (52.6%) were hypertensive, Diabetic 66(48%), Smoker 70 (51%) and FH positive for CAD were 31 (22.6%). According to the involvement of myocardium infarction, STEMI diagnosis of Anterior MI were 48.9% (n=67) and Inferior MI 51.1% (n=70). An elevated serum creatinine level was defined as creatinine >1.2mg/dl. Based on baseline serum creatinine level, patients were divided into group-A and Group-B. In Group-A. Total 68 patients have S. Creatinine level <1.2 and in Group-B, 69 patients have S. Creatinine level >1.2. Anterior MI were higher in group -B patient than Group-A; Ant MI as 35 (50.4%) vs 31(45.6%), Inf MIL: 34 (49.35) vs 34 (50%), Shock 11 (15.9%) vs 6 (8.8%0, CHB 4 (5.8%) vs 4 (5.9%), Death 12 (17.4%) vs 2 (2.9%) and LVF 5(7.2%) vs 1(1.5%) with 7 days in-hospital stay after primary PCI. Territory wise involvement of vessel in Group-B patient has more involvement of LAD 35 (50.7%) and Group-A has RCA 26(38.2%). Conclusion: In this present study, we found, that in acute STEMI patients, baseline higher serum creatinine level is associated with more AMI related complications and death than in lower serum creatinine level. Thus, we may conclude that baseline admission serum creatinine level may be an important predictor for both in-hospital and 12-month survival outcomes in STEMI patients undergoing pPCI. Cardiovasc. j. 2020; 12(2): 135-142

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