scholarly journals Ifosfamide May Be Safely Used in Patients with End Stage Renal Disease on Hemodialysis

Sarcoma ◽  
2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
Sheron Latcha ◽  
Robert G. Maki ◽  
Gary K. Schwartz ◽  
Carlos D. Flombaum
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Response To Therapy ◽  
Common Side Effect ◽  
Pharmacokinetic Data ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage ◽  
Metastatic Sarcoma ◽  
Radiographic Improvement

Background. Pharmacokinetic data on clearance of ifosfamide in hemodialysis patients are limited. Consequently, these patients are excluded from therapy with this agent. We review the outcomes for patients at our institution with end stage renal disease on dialysis who received ifosfamide for metastatic sarcoma.Patients and Methods. We treated three patients with end stage renal disease on hemodialysis with escalating doses of ifosfamide. Data on radiographic response to therapy, WBC and platelet counts, signs or symptoms of infection, neuropathy and bladder toxicity are reported. Starting doses of ifosfamide were based on review of the literature available with subsequent modifications based on each patient's prior exposure to myelosuppressive agents and on symptoms of neurotoxicity and the degree of myelosuppression following each cycle of chemotherapy.Results. Myelosuppression was the most common side effect from therapy, but no patient developed a life threatening infection, neurotoxicity, or hematuria. One patient developed epistaxis in the setting of thrombocytopenia while on warfarin therapy. All patients had clinical evidence for therapeutic response and two had documented radiographic improvement following ifosfamide administration.Conclusion. Ifosfamide can be used safely in combination with hemodialysis in patients with end stage renal disease.

scholarly journals Efficacy of Nivolumab in a Patient with Metastatic Renal Cell Carcinoma and End-Stage Renal Disease on Dialysis: Case Report and Literature Review

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Jawaher Ansari ◽  
Muhammad Ali ◽  
Ashraf Farrag ◽  
Arwa M. Ali ◽  
Abdulaziz Alhamad
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Disease ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
End Stage Renal Disease ◽  
Renal Cell ◽  
Pharmacokinetic Data ◽  
Management Options ◽  
Stage Renal Disease ◽  
End Stage

Treatment of patients with metastatic renal cell carcinoma (mRCC) and end-stage renal disease (ESRD) on dialysis poses a therapeutic challenge, particularly as this patient group was excluded from the pivotal clinical trials. In addition, there is uncertainty regarding drug dosing/pharmacokinetics, lack of safety and efficacy data, and potential for increased toxicity when using targeted therapy or immunotherapy for the management of patients with mRCC on dialysis. Nivolumab, an anti-programmed death-1 immune checkpoint inhibitor antibody, is indicated for the treatment of patients with mRCC who have received prior antiangiogenic therapy. Given the above-mentioned uncertainties, clinicians may be reluctant to use nivolumab for this patient population, leading to potential denial of life-prolonging medications. We report the case of a 72-year-old gentleman with mRCC and ESRD on dialysis who received second-line nivolumab therapy and achieved an excellent symptomatic and radiological response, remaining progression-free for over 22 months. In addition, we have reviewed the pharmacokinetic data and published retrospective case studies to review the management options for patients with mRCC and ESRD on dialysis.

The patient with vasculitis

2015 ◽  
Author(s):  
Lorraine Harper ◽  
David Jayne
Keyword(s):  
Renal Impairment ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Drug Toxicity ◽  
Response To Therapy ◽  
Renal Outcome ◽  
Remission Induction ◽  
Renal Vasculitis ◽  
Stage Renal Disease ◽  
End Stage

The goals of treatment in renal vasculitis are to stop vasculitic activity and recover renal function. Subsequent strategies are required to prevent vasculitis returning and to address longer-term co-morbidities caused by tissue damage, drug toxicity, and increased cardiovascular and malignancy risk.Cyclophosphamide and high-dose glucocorticoids remain the standard induction therapy with alternative immunosuppressives, such as azathioprine, to prevent relapse. Plasma exchange improves renal recovery in severe presentations. Refractory disease resulting from a failure of induction or remission maintenance therapy requires alternative agents and rituximab has been particularly effective. Replacement of cyclophosphamide by rituximab for remission induction is supported by recent evidence. Methotrexate is effective in non-renal vasculitis but difficult to use in patients with renal impairment. Mycophenolate mofetil seems to be effective but there is less long-term evidence.Drug toxicity contributes to co-morbidity and mortality and has led to newer regimens with reduced cyclophosphamide exposure. Glucocorticoid toxicity remains a major problem with controversy over the rapidity with which glucocorticoids can be reduced or withdrawn.Disease relapse occurs in about 50% of patients. Early detection is less likely to lead to an adverse affect on outcomes. Rates of cardiovascular disease and malignancy are higher than in control populations but strategies to reduce their risk, apart from cyclophosphamide-sparing regimens, have not been developed. Thromboembolic events occur in 10% and may be linked to the recently identified autoantibodies to plasminogen and tissue plasminogen activator.Renal impairment at diagnosis is a strong predictor of patient survival and renal outcome. Other predictors include patient age, antineutrophil cytoplasmic antibody subtype, disease extent and response to therapy. Chronic kidney disease can stabilize for many years but the risks of end-stage renal disease are increased by acute kidney injury at presentation or renal relapse. Renal transplantation is successful with similar outcomes to other causes of end-stage renal disease.

Hemorrhage as a life-threatening complication after valve replacement in end-stage renal disease patients

2015 ◽  
Vol 63 (7) ◽  
pp. 386-394 ◽  
Author(s):  
Taro Nakatsu ◽  
Nobushige Tamura ◽  
Shigeki Yanagi ◽  
Shoichi Kyo ◽  
Takaaki Koshiji ◽  
...  
Keyword(s):  
Renal Disease ◽  
Valve Replacement ◽  
End Stage Renal Disease ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Vancomycin Induced Thrombocytopenia – Protracted Course in a Hemodialysis Patient

2019 ◽  
Vol 12 (3) ◽  
pp. 749-754 ◽  
Author(s):  
Nisha Elizabeth Ajit ◽  
Sindhu Priya Devarashetty ◽  
Samip Master
Keyword(s):  
Renal Disease ◽  
Renal Clearance ◽  
End Stage Renal Disease ◽  
Side Effect ◽  
Hemodialysis Patient ◽  
Treatment Modalities ◽  
Platelet Destruction ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage

Vancomycin induced thrombocytopenia (VIT) is an uncommon side effect of vancomycin which can manifest from mild petechiae to life-threatening bleed. Decreased renal clearance of vancomycin results in prolonged thrombocytopenia by antibody-mediated platelet destruction in the presence of vancomycin. Improvement in thrombocytopenia is achieved with the elimination of vancomycin. We describe a patient with end stage renal disease who experienced a protracted course of thrombocytopenia from vancomycin. We illustrate the mechanism of thrombocytopenia and the treatment modalities used by us and those described in literature. VIT is an important differential in patients with thrombocytopenia admitted to the hospital.

Cutaneous manifestations of end-stage renal disease

2015 ◽  
Author(s):  
Timur A. Galperin ◽  
Kieron S. Leslie ◽  
Antonia J. Cronin
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Skin Diseases ◽  
Treatment Options ◽  
Electrolyte Imbalance ◽  
Cutaneous Manifestations ◽  
Metastatic Calcification ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage

A broad range of skin diseases occur in patients with end-stage renal disease. Some of these conditions are benign, and make little impact on patients’ lives. Others, however, have a greater impact on quality of life, may be physically disabling, and even life-threatening. Mostly, they result from a combination of factors, such as electrolyte imbalance and co-morbid disease. Uraemic pruritus is the most commonly troublesome and an approach to it is presented. Other non-specific skin manifestations of CKD include skin-colour changes, xerosis, half-and-half nails Specific manifestations include acquired perforating dermatosis, bullous dermatoses, metastatic calcification, and nephrogenic systemic fibrosis. Pathophysiology, clinical presentation, diagnosis, and treatment options are discussed.

scholarly journals Investigating Clinically Adequate Concentrations of Oseltamivir Carboxylate in End-Stage Renal Disease Patients Undergoing Hemodialysis Using a Population Pharmacokinetic Approach

2015 ◽  
Vol 59 (11) ◽  
pp. 6774-6781 ◽  
Author(s):  
Mohamed A. Kamal ◽  
Kayla Yi Ting Lien ◽  
Richard Robson ◽  
Vishak Subramoney ◽  
Barry Clinch ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Population Pharmacokinetic ◽  
High Risk Population ◽  
Pharmacokinetic Data ◽  
Oseltamivir Carboxylate ◽  
Mixed Effects Modeling ◽  
Dose Study ◽  
Stage Renal Disease ◽  
End Stage

ABSTRACTEnd-stage renal disease (ESRD) patients receiving hemodialysis (HD) are at heightened risk for influenza, but the optimal oseltamivir dosage regimen for treating or preventing influenza in this high-risk population is still uncertain. Pharmacokinetic data for 24 adults with ESRD were pooled from a single-dose and a multiple-dose study to develop a population pharmacokinetic model using nonlinear mixed-effects modeling. The final model comprised five compartments, two each to describe the systemic pharmacokinetics of oseltamivir phosphate and its metabolite, oseltamivir carboxylate (OC), and a delay compartment to describe oseltamivir metabolism. Estimated OC clearance in the model was markedly faster during HD sessions (7.43 liters/min) than at other times (0.19 liter/min). Model simulations showed that 30 mg oseltamivir given after every HD session is the most suitable regimen for influenza treatment, producing trough OC concentrations above the median value achieved with the 75-mg twice-daily regimen in patients with normal renal function and peak concentrations below the highest oseltamivir exposures known to be well tolerated (median exposures after twice-daily dosing of 450 mg). Administration of the first dose following diagnosis of influenza need not wait until after the next HD session: addition of a single 30-mg dose during the 12 h before the next HD session raises OC exposures quickly without posing any safety risk. Further simulation showed that 30 mg oseltamivir given after every other HD session is the most suitable regimen for influenza prophylaxis.

Ertapenem-Associated Seizures in a Peritoneal Dialysis Patient

2005 ◽  
Vol 39 (2) ◽  
pp. 352-356 ◽  
Author(s):  
Arnold H Seto ◽  
Jessica C Song ◽  
Steven S Guest
Keyword(s):  
Clinical Trials ◽  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Safety Data ◽  
Peritoneal Dialysis Patient ◽  
Pharmacokinetic Data ◽  
Do Not Resuscitate ◽  
Stage Renal Disease ◽  
End Stage

OBJECTIVE: To report a case of a patient undergoing peritoneal dialysis who developed refractory seizures after 2 doses of ertapenem. CASE SUMMARY: A 56-year-old white man with end-stage renal disease requiring continuous ambulatory peritoneal dialysis experienced 5 seizures following 2 doses of ertapenem 500 mg given intravenously. The first generalized tonic—clonic seizure occurred 16 hours after the second ertapenem dose and lasted 3 minutes. Three hours after his first seizure, the patient experienced 2 more seizures 15 minutes apart, lasting 3 minutes each. After suffering a fifth seizure, the patient became apneic and pulseless and was not resuscitated, as he had previously requested a “do not resuscitate” status. DISCUSSION: Carbapenem treatment has been associated with simple partial, complex partial, and generalized tonic—clonic seizures, with generalized seizures representing the most frequently occurring type. Safety data from 7 published clinical trials of ertapenem revealed a seizure incidence of 0.18%. To our knowledge, there are no previously published reports of ertapenem neurotoxicity in patients undergoing peritoneal dialysis. Moreover, little information is available regarding the pharmacokinetics of carbapenems in end-stage renal disease. Ertapenem pharmacokinetics were not tested in any patients receiving peritoneal dialysis during published clinical trials. CONCLUSIONS: Our patient experienced 5 seizures, possibly induced by ertapenem, as validated by the Naranjo probability scale. Clinicians administering ertapenem to patients undergoing peritoneal dialysis should use caution, as clinical experience with the agent is limited and pharmacokinetic data are lacking.

scholarly journals Hyperkalemic Recurrent Bilateral Lower Extremity Weakness in a Patient on Hemodialysis

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Getaw Worku Hassen ◽  
Suzanne Newstead ◽  
Lorraine Maria Giordano
Keyword(s):  
Lower Extremity ◽  
Renal Disease ◽  
Neurological Deficit ◽  
End Stage Renal Disease ◽  
Focal Neurological Deficit ◽  
Lower Extremity Weakness ◽  
Electrolyte Disorder ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage

Hyperkalemia is a severe life-threatening electrolyte disorder that commonly affects the cardiac conductivity and contractility. Ascending paralysis affecting the extremities with focal neurological deficit as well as quadriparesis and a seizure associated with hyperkalemia has been reported in the literature. Here, we describe a case of isolated recurrent lower extremity paralysis and an episode of seizure in an 83-year-old patient with end-stage renal disease on hemodialysis.

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