Estimation of Creatinine Clearance in Patients with Cushing's Syndrome

DICP ◽  
1989 ◽  
Vol 23 (12) ◽  
pp. 974-977 ◽  
Author(s):  
Jimmi Hatton ◽  
Michael D. Parr ◽  
Robert A. Blouin
Keyword(s):  
Body Weight ◽  
Creatinine Clearance ◽  
Cushing’S Syndrome ◽  
Ideal Body Weight ◽  
Total Body Weight ◽  
Cushing's Syndrome ◽  
Normal Weight ◽  
Poor Correlation ◽  
Obese Patients ◽  
Total Body

The predictive value of the Cockcroft-Gault equation in patients with Cushing's syndrome was evaluated in 23 patients. Patients were subdivided based on total body weight into two groups, obese and nonobese. Estimated creatinine clearance (EC1cr) values were obtained by the Cockcroft-Gault method using ideal body weight (IBW) and total body weight (TBW). These values were then compared with a 24-hour measured creatinine clearance (MClcr). EClcr values based on TBW consistently overestimated measured values in all patients (p<0.05). In obese patients with Cushing's syndrome IBW predictions were not statistically different. However, linear regresson analysis revealed a poor correlation (r=0.32). Daily creatinine production rates (Ucr) were calculated and contrasted with an appropriate historical control for obese and nonobese subjects. Nonobese patients revealed a marked reduction in total Ucr compared with normal-weight controls (p<0.05). Obese patients also showed a reduction in Ucr when compared with a normal obese control population (p<0.05). Difficulty in predicting creatinine clearance in patients with Cushing's syndrome appears to be related to alterations in Ucr. These data suggest that the pathophysiologic changes that accompany Cushing's syndrome are sufficient to alter Ucr and may limit the usefulness of existing methods to predict creatinine clearance and renal function in these patients.

P0264ASSESSMENT OF GFR IN MORBIDLY OBESE PATIENTS USING DIFFERENT EQUATIONS: WHICH IS THE BEST?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Alaa Sabry ◽  
Amir Basiony ◽  
Mohamed Kamal
Keyword(s):  
Body Weight ◽  
Creatinine Clearance ◽  
Glomerular Filtration ◽  
Total Body Weight ◽  
Lean Body Weight ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Morbidly Obese Patient ◽  
Gault Formula ◽  
Total Body

Abstract Background and Aims Obesity is a potent risk factor for the development of kidney disease. The prevalence of abdominal obesity in Egyptians based upon the European cut-off points was 30.2% for men and 70.9% for women. To detect the best formula for estimation of glomerular filtration rates in morbidly obese individuals. Method: In this prospective study 82 morbidly obese patients were included, Age: 15 to 65 years, Morbidly obese patient (BMI &gt; 40 Kg/m2), Creatinine clearance calculated from a 24-h urine was done, Estimated glomerular filtration rate (eGFR): It was assessed to be correlated with creatinine clearance and detect the most suitable formula for morbidly obese patients. Cockcroft-Gault formula:  Cockcroft-Gault formula (for total body weight): ockcroft-Gault formula (for adjusted body weight): Cockcroft-Gault formula (for lean body weight), MDRD-eGFR (Modification of Diet in Renal Disease equation) (Shahbaz & Gupta, 2019), CKD-epidemiology (CKD-EPI): (Levey, et al, 2009) Results Demogrphic criteria of the studdied patients Conclusion: The equations that had the nearest values to creatinine clearance were CG-TBW-GFR and CGAjBW- GFR, both of them had a moderate reliability with more agreement for the CG-TBW-GFR equation . The CG-TBW-GFR formula was the most reliable one to measure GFR, followed by the CG-AjBW-GFR formula, while the CG-IBW, CG-LBW, MDRD-GFR and CKD-EPI-GFR formulae were not reliable at all .

scholarly journals Comparative evaluation of atracurium dosed on ideal body weight vs. total body weight in morbidly obese patients

2010 ◽  
Vol 71 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Simone Van Kralingen ◽  
Ewoudt M. W. Van De Garde ◽  
Catherijne A. J. Knibbe ◽  
Jeroen Diepstraten ◽  
Marinus J. Wiezer ◽  
...  
Keyword(s):  
Body Weight ◽  
Comparative Evaluation ◽  
Ideal Body Weight ◽  
Total Body Weight ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Ideal Body ◽  
Total Body

Theophylline Clearance in Obese Patients in Relation to Smoking and Congestive Heart Failure

1983 ◽  
Vol 17 (4) ◽  
pp. 274-276 ◽  
Author(s):  
Richard L. Slaughter ◽  
Robert A. Lanc
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Body Weight ◽  
Ideal Body Weight ◽  
Total Body Weight ◽  
Obese Patients ◽  
Ideal Body ◽  
Total Body ◽  
Nonobese Patients ◽  
Body Clearance

The effect of obesity on the total body clearance (Cltot) of theophylline was evaluated in nonsmokers and smokers with and without congestive heart failure (CHF). The obese patients were compared with similar nonobese subjects with regard to age, sex, and disease state. The total patient population numbered 150 adults. Cltot of theophylline, based on total body weight (TBW), averaged 0.60 ± 0.20 ml/min/kg in obese nonsmokers and did not differ from the nonobese, nonsmoking group. In obese nonsmoking patients with CHF, Cltot based on TBW was 0.40 ± 0.14 ml/min/kg, which was similar to Cltot values in nonsmoking CHF patients who were not obese. A trend toward a reduction in Cltot, based on TBW, as TBW increased, in nonsmoking patients with and without CHF, was observed. In contrast to the Cltot in nonsmokers, the Cltot of theophylline in obese smokers with and without CHF was similar to the Cltot values in nonobese populations only when based on ideal body weight. However, when compared with nonsmoking, nonobese patients, no differences were observed when Cltot was corrected for TBW. These findings suggest that theophylline maintenance dose can be based on TBW in obese patients who are smokers and nonsmokers (with and without CHF), using the average Cltot obtained for the nonsmoking patients with and without CHF.

scholarly journals 2109. Liposomal Amphotericin B-associated Nephrotoxicity in Obese and Non-obese Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S714-S714
Author(s):  
Brandon Tritle ◽  
Logan Peterson ◽  
Jared Olson ◽  
Emily Benefield ◽  
Paloma F Cariello ◽  
...  
Keyword(s):  
Body Weight ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Ideal Body Weight ◽  
Total Body Weight ◽  
Liposomal Amphotericin B ◽  
Obese Patients ◽  
Daily Dose ◽  
Ideal Body ◽  
Total Body

Abstract Background Liposomal amphotericin B (L-amb) is an important antifungal agent which exhibits significant rates of dose-dependent nephrotoxicity. Animal studies demonstrate only small amounts of L-amb distribute into adipose tissue and obese animals show greater risk of nephrotoxicity with L-amb administration. This study aims to determine whether obese patients are at a higher risk of nephrotoxicity with weight-based doses of L-amb. Methods We performed a multi-center, retrospective cohort study of nephrotoxicity with L-amb in obese (BMI > 30) and non-obese adult patients at University of Utah Health and Intermountain Healthcare from January 1, 2014 through December 31, 2018. Our primary outcome was the rate of nephrotoxicity as determined by AKIN criteria. Patients receiving at least one dose of L-amb were identified for inclusion. Patients were excluded if they were already on a renal replacement at the time of L-amb initiation or they received L-amb prior to admission. Results We included 221 patients, 47 (21%) were obese and 174 (79%) were non-obese. Median total body weight was 109 kg in obese patients compared with 70 kg in non-obese patients. Dosage based on ideal body weight was higher in the obese group (median 6.9 mg/kg vs. 4.9 mg/kg). Obese patients were significantly more likely to experience acute kidney injury (AKI) than non-obese patients (55% vs. 37%, P = 0.03). Patients who experienced nephrotoxicity received a higher average daily dose than those who did not (365 mg vs. 333 mg, P = 0.03), had a higher median cumulative dose (3,130 mg vs. 1,700 mg, P < 0.001), and had a higher median total body weight (79.6 kg vs. 71.9 kg, P = 0.04.). Additionally, daily dose normalized to total body weight was not associated with AKI (median 4.7 mg/kg in patients with AKI vs. 4.8 mg/kg in patients without AKI, P = 0.86). However, daily dose normalized to ideal body weight was associated with AKI (median 5.5 mg/kg in patients with AKI vs. 4.9 mg/kg in patients without AKI, P = 0.02). Conclusion We identified a higher rate of nephrotoxicity among obese patients receiving L-amb compared with non-obese patients. These data suggest that dosing L-amb based on total body weight places obese patients at a higher risk of nephrotoxicity. This should be considered when assessing the risks and benefits of this dosing strategy in obese patients. Disclosures All authors: No reported disclosures.

Estimation of Total Body Weight in Obese Patients

2009 ◽  
Vol 28 (3) ◽  
pp. 139-145 ◽  
Author(s):  
Cameron S. Crandall ◽  
Stephanie Gardner ◽  
Darren A. Braude
Keyword(s):  
Body Weight ◽  
Total Body Weight ◽  
Obese Patients ◽  
Total Body

A universal formula based on cystatin C to perform individual dosing of carboplatin in normal weight, underweight, and obese patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 2527-2527
Author(s):  
E. Chatelut ◽  
A. Schmitt ◽  
A. Lansiaux ◽  
C. Bobin-Dubigeon ◽  
M. Etienne-Grimaldi ◽  
...  
Keyword(s):  
Body Weight ◽  
Lean Body Mass ◽  
Body Mass ◽  
Cystatin C ◽  
Ideal Body Weight ◽  
Normal Weight ◽  
Percentage Error ◽  
Pharmacokinetic Analysis ◽  
Obese Patients ◽  
Ideal Body

2527 Background: It has recently been shown that it is possible to improve the prediction of carboplatin clearance by adding plasma cystatin C level (cysC), an endogenous marker of glomerular filtration rate, to the other patient characteristics routinely used for carboplatin individual dosing, namely serum creatinine (Scr), body weight (BW), age, and sex. This multi-center pharmacokinetic study was performed to evaluate prospectively the benefit of using cysC for carboplatin individual dosing. Methods: The 357 patients included in the study were receiving carboplatin as part of established protocols. A population pharmacokinetic analysis was performed using the NONMEM program. Seven covariates were studied: Scr, cysC, age, sex, BW, ideal body weight, and lean body mass. Results: The best covariate equation was: carboplatin clearance (mL/min) = 105. (Scr/75)-0.433. (cysC/1.00)-0.290 . (BW/65)+0.547 . (age/56)-0.351 . 0.855sex, with Scr in μmol/L, cysC in mg/L, BW in kg, age in years, and sex = 0 for male. Using an alternative weight descriptor (ideal body weight or lean body mass) did not improve the prediction. This final covariate model was validated by bootstrap analysis. The bias (mean percentage error) and imprecision (mean absolute percentage error) were +2% and 15% respectively on the total population, and were of a similar magnitude in each of the three subgroups of patients defined according to their body mass index. Conclusions: For the first time, a unique formula is proposed for carboplatin individual dosing to patients which is shown to be equally valid for underweight, normal weight, and obese patients. No significant financial relationships to disclose.

985: SEDATION DOSING BASED ON IDEAL BODY WEIGHT VERSUS TOTAL BODY WEIGHT IN THE INTENSIVE CARE UNIT

2018 ◽  
Vol 46 (1) ◽  
pp. 476-476
Author(s):  
Julianne Yeary ◽  
Alexandra Greco ◽  
Rich Mcknight ◽  
Karen Petros ◽  
Jefferey Garavaglia
Keyword(s):  
Intensive Care Unit ◽  
Body Weight ◽  
Intensive Care ◽  
Ideal Body Weight ◽  
Total Body Weight ◽  
Ideal Body ◽  
Total Body

The Impact of Obesity and Disease on Busulfan Oral Clearance in Adults

Blood ◽  
1999 ◽  
Vol 93 (12) ◽  
pp. 4436-4440
Author(s):  
John P. Gibbs ◽  
Ted Gooley ◽  
Bruce Corneau ◽  
Georgia Murray ◽  
Patricia Stewart ◽  
...  
Keyword(s):  
Body Weight ◽  
Ideal Body Weight ◽  
Normal Weight ◽  
Myelogenous Leukemia ◽  
Obese Patients ◽  
Oral Clearance ◽  
Plasma Level Monitoring ◽  
Ideal Body ◽  
The Impact ◽  
Level Monitoring

The apparent oral clearance (CL/F, mL/min) of busulfan was measured in 279 adolescent and adult patients. Significant (P< .05) determinants of CL/F by linear regression were: actual body weight (BW; r2 = 0.300), body surface area (BSA; r2 = 0.277), adjusted ideal body weight (AIBW; r2 = 0.265), and ideal body weight (IBW; r2= 0.173); whereas body mass index (BMI), height, age, gender, and disease were less important predictors. CL/F (mL/min) for normal weight patients (BMI, 18 to 27 kg/m2) was 16.2% lower (P< .001) than for obese patients (BMI, 27 to 35 kg/m2). Thus, expressing CL/F relative to BW did not eliminate statistically significant differences between normal and obese patients. However, busulfan CL/F expressed relative to BSA (110 ± 24 v 110 ± 24 mL/min/m2, P = 1.0) or AIBW (3.04 ± 0.65 v 3.19 ± 0.67 mL/min/kg, P = .597) were similar in normal and obese patients. Non-Hodgkin’s lymphoma patients (n = 10) had approximately 32% lower mean busulfan CL/F expressed relative to BW, BSA, or AIBW compared with patients with chronic myelogenous leukemia (n = 73). Routine dosing on the basis of BSA or AIBW in adults and adolescents does not require a specific accommodation for the obese. However, dosing based on BSA may be improved by considering CL/F differences in certain diseases. Adjusting dose for body size or disease does not diminish interpatient variability sufficiently to obviate plasma level monitoring in many indications.

Sign in / Sign up

Export Citation Format

Share Document