scholarly journals Concordance Among Methods for Empiric Renal Drug Dosing: Meropenem as a Role Model for Clinical Superiority of Cockroft–Gault or Modification of Diet in Renal Disease

2018 ◽  
Vol 10 ◽  
pp. 1179559X1877776
Author(s):  
Sabaa M Al Jasmi ◽  
Amer H Khan ◽  
Loai M Saadah ◽  
Syed Azhar Syed Sulaiman ◽  
Doaa Kamal Al Khalidi
Keyword(s):  
Renal Function ◽  
Renal Disease ◽  
Role Model ◽  
Simulated Data ◽  
Adverse Outcomes ◽  
Drug Dosing ◽  
Disease Epidemiology ◽  
Actual Patient ◽  
Specific Medication ◽  
Clinically Significant

Objective: The objectives of this study are, first, to measure concordance between 5 different renal function estimates (methods) in terms of recommended drug doses, and, subsequently, to establish the potential for significant clinical differences between Cockroft–Gault (CG) and Modification of Diet in Renal Disease (MDRD) equations in dosing a specific medication, namely, meropenem. Design and setting: This study used a Monte Carlo simulation, and this is a computer–based study with no actual patient data. Patients: A total of 1200 and 8701 simulated cases to study the concordance for the 5 methods and the potential clinical significance of discordance between CG and MDRD, respectively, were chosen for the study. Methods: Simulated factors were age, sex, height, weight, serum creatinine, ethnicity, and albumin. We estimated the renal function using 5 formulas (ie, 10 combinations) including CG, MDRD, and Chronic Kidney Disease Epidemiology Collaboration (CKD–EPI). Next, the team evaluated concordance for each combination in dosing 22 drugs. Finally, our researchers reviewed and simulated data from the literature to show how CG versus MDRD use can result in clinically significant differences for meropenem. Results: Pairwise combinations yielded statistically significant differences ( P < .0001) except for CG and MDRD ( P < .5147). In addition, the highest concordance was for MDRD and CKD–EPI. Average discordance is in the range of 25% to 30% with the lowest being between CG and albumin–based estimates. Both CG and MDRD were largely discordant which can reach up to 40% with a drug like meropenem and may be associated with significant adverse outcomes. Conclusions: Both CG and MDRD in our simulation are statistically comparable. Clinically, nonetheless, they are significantly inconsistent in terms of recommended drug dosing. We encourage practical comparisons of outcomes for individual or groups of medications (eg, meropenem and antibiotics) empirically dosed in renal patients on the basis of equations used in distinct populations.

scholarly journals Predictive performance of the estimating equations of renal function in Sri Lankan subjects

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Ranga Migara Weerakkody ◽  
Mohammed Hussain Rezvi Sheriff
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Renal Disease ◽  
Creatinine Clearance ◽  
Sri Lankan ◽  
Predictive Equations ◽  
Disease Epidemiology ◽  
Renal Functions ◽  
Significant Difference

Abstract Objectives This study validates two popular predictive equations of renal function firstly, Modifications of Diet in Renal Disease and secondly, Chronic Kidney Disease Epidemiology Collaboration equations for Sri Lankan cohort. We used data of the patients referred to Renal Research lab of University of Colombo for creatinine clearance measurement. Results Predictive performances varied with the gender. Creatinine clearance and predicted renal functions were compared. Both fared unsatisfactorily with R2 ranging from 0.632 to 0.652, and overestimated renal function by 6–15%. The proportion chronic kidney disease staging 1 and 2 returned by Chronic Kidney Disease Epidemiology Collaboration equation showed significant difference, in females. Modifications of Diet in Renal Disease equation significantly under-estimated advanced chronic kidney disease in females. Chronic Kidney Disease Epidemiology Collaboration equation had better accuracy. The study sample had more females, Asian and lower body size and better renal functions than historic cohorts. Thai and Pakistani studies show both equations and their Asian adaptations fare poorly. Chronic kidney disease stages differ significantly with the equation used. Predictive equations have fared unsatisfactorily by overestimating renal functions. We recommend further studies using gold standards of measuring renal function.

Comparison of bedside estimates of renal function and measured glomerular filtration rate (GFR) in 510 adult oncology patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19512-19512
Author(s):  
M. J. Dooley ◽  
S. G. Poole ◽  
D. Rischin
Keyword(s):  
Renal Function ◽  
Renal Disease ◽  
Clinical Utility ◽  
Chronic Renal Disease ◽  
Oncology Patients ◽  
Drug Dosing ◽  
Mdrd Equation ◽  
The Mean ◽  
And Gender ◽  
Measured Gfr

19512 Background: Various bedside formulae have been used in practice to estimate renal function to predict drug dosing. Recently the ‘4-variable Modification of Diet in Renal Disease’ (4-v MDRD) equation1 was derived in patients with chronic renal disease and has been advocated for application in oncology. The aim of this study was to compare measured GFR with estimates from formula based equations in adult oncology patients. Methods: GFR was determined using technetium-99m diethyl triamine penta-acetic acid (Tc99mDTPA) clearance, serum creatinine (Jaffe method) was measured and renal function estimates calculated using 4-v MDRD, Cockcroft and Gault (CGF), Wright, Martin, and Jelliffe (JF) formulae. Accuracy, bias (mean % error (MPE)) and precision were assessed for varying levels of GFR, body mass index (BMI), age and gender. Results: In 510 adult oncology patients (323 male, 187 female, mean age 63years, range 17–87years) GFR was determined using Tc99mDTPA clearance (mean 84mL/min, range 16–205mL/min). The mean (range) calculated GFR was 72mL/min/1.73m2(9–162mL/min/1.73m2), 71ml/min (11–267mL/min), 78mL/min (12- 195mL/min), 81mL/min (12–279mL/min), 64mL/min/1.73m2 (10–165mL/min/1.73m2) for 4-v MDRD, CGF, Wright, Martin, and JF formula respectively. Bias, precision and accuracy (%within 30% and 50% of true GFR) of estimates are shown in the table . The Wright and Martin formulae had greater bias relating to degree of renal function and gender respectively. The 4-v MDRD equation provided a less biased estimate compared to the CGF across all levels of renal function and BMI. Conclusions: When compared to measured GFR, the 4-v MDRD equation provides a less biased estimate compared to the other formulae evaluated across a range of variables including degree of renal function and BMI. The limitations of all the bedside estimates must be understood to allow appropriate clinical utility. 1. Levey AS, et al. Ann Intern Med 2006; 145: 247–254. [Table: see text] No significant financial relationships to disclose.

Plasma D Dimer: A Useful Marker of Fibrin Breakdown in Renal Failure

1989 ◽  
Vol 61 (03) ◽  
pp. 522-525 ◽  
Author(s):  
M P Gordge ◽  
R W Faint ◽  
P B Rylance ◽  
H Ireland ◽  
D A Lane ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Monoclonal Antibodies ◽  
Diabetic Nephropathy ◽  
Renal Disease ◽  
Plasma Concentrations ◽  
Significant Negative Correlation ◽  
Healthy Controls ◽  
D Dimer

SummaryD dimer and other large fragments produced during the breakdown of crosslinked fibrin may be measured by enzyme immunoassay using monoclonal antibodies. In 91 patients with renal disease and varying degrees of renal dysfunction, plasma D dimer showed no correlation with renal function, whereas FgE antigen, a fibrinogen derivative which is known to be cleared in part by the kidney, showed a significant negative correlation with creatinine clearance. Plasma concentrations of D dimer were, however, increased in patients with chronic renal failure (244 ± 3l ng/ml) (mean ± SEM) and diabetic nephropathy (308 ± 74 ng/ml), when compared with healthy controls (96 ± 13 ng/ml), and grossly elevated in patients with acute renal failure (2,451 ± 1,007 ng/ml). The results indicate an increase in fibrin formation and lysis, and not simply reduced elimination of D dimer by the kidneys, and are further evidence of activated coagulation in renal disease. D dimer appears to be a useful marker of fibrin breakdown in renal failure.

scholarly journals Comparison of laparoscopic and hand-assisted laparoscopic nephrectomy for inflammatory renal disease: which is the preferred approach?

2021 ◽  
Vol 13 ◽  
pp. 175628722098404
Author(s):  
Xudong Guo ◽  
Hanbo Wang ◽  
Yuzhu Xiang ◽  
Xunbo Jin ◽  
Shaobo Jiang
Keyword(s):  
Logistic Regression ◽  
Renal Disease ◽  
Complication Rate ◽  
Adverse Outcomes ◽  
Laparoscopic Nephrectomy ◽  
Multivariable Logistic Regression Analysis ◽  
Invasive Approach ◽  
Intraoperative Complication ◽  
Multivariable Logistic Regression ◽  
Significant Difference

Aims: Management of inflammatory renal disease (IRD) can still be technically challenging for laparoscopic procedures. The aim of the present study was to compare the safety and feasibility of laparoscopic and hand-assisted laparoscopic nephrectomy in patients with IRD. Patients and methods: We retrospectively analyzed the data of 107 patients who underwent laparoscopic nephrectomy (LN) and hand-assisted laparoscopic nephrectomy (HALN) for IRD from January 2008 to March 2020, including pyonephrosis, renal tuberculosis, hydronephrosis, and xanthogranulomatous pyelonephritis. Patient demographics, operative outcomes, and postoperative recovery and complications were compared between the LN and HALN groups. Multivariable logistic regression analysis was conducted to identify the independent predictors of adverse outcomes. Results: Fifty-five subjects in the LN group and 52 subjects in the HALN group were enrolled in this study. In the LN group, laparoscopic nephrectomy was successfully performed in 50 patients (90.9%), while four (7.3%) patients were converted to HALN and one (1.8%) case was converted to open procedure. In HALN group, operations were completed in 51 (98.1%) patients and conversion to open surgery was necessary in one patient (1.9%). The LN group had a shorter median incision length (5 cm versus 7 cm, p < 0.01) but a longer median operative duration (140 min versus 105 min, p < 0.01) than the HALN group. There was no significant difference in blood loss, intraoperative complication rate, postoperative complication rate, recovery of bowel function, and hospital stay between the two groups. Multivariable logistic regression revealed that severe perinephric adhesions was an independent predictor of adverse outcomes. Conclusion: Both LN and HALN appear to be safe and feasible for IRD. As a still minimally invasive approach, HALN provided an alternative to IRD or when conversion was needed in LN.

Sign in / Sign up

Export Citation Format

Share Document