scholarly journals Anti-Xa Activity of Enoxaparin for Prevention of Venous Thromboembolism in Severe Nephrotic Syndrome—A Single Center Prospective Study

2021 ◽  
Vol 10 (23) ◽  
pp. 5709
Author(s):  
Anna Matyjek ◽  
Aleksandra Rymarz ◽  
Zuzanna Nowicka ◽  
Slawomir Literacki ◽  
Tomasz Rozmyslowicz ◽  
...  
Keyword(s):  
Body Weight ◽  
Nephrotic Syndrome ◽  
Dose Adjustment ◽  
Ideal Body Weight ◽  
Optimal Dose ◽  
Fixed Dose ◽  
Bivariate Model ◽  
Risk Threshold ◽  
Venous Thromboembolic Events ◽  
Ideal Body

Severe nephrotic syndrome (NS) is associated with high risk of venous thromboembolic events (VTE), as well as presumably altered heparin pharmacokinetics and pharmacodynamics. Although prophylactic anticoagulation is recommended, the optimal dose is not established. The aim of the study was to test two co-primary hypotheses: of reduced enoxaparin effectiveness and of the need for dose-adjustment in NS. Forty two nephrotic patients with serum albumin ≤2.5 g/dL were alternately assigned to a standard fixed-dose of enoxaparin (NS-FD: 40 mg/day) or ideal body weight (IBW)-based adjusted-dose (NS-AD: 1 mg/kg/day). Twenty one matched non-proteinuric individuals (C-FD) also received fixed-dose. Co-primary outcomes were: the achievement of low- and high-VTE risk threshold of antifactor-Xa activity (anti-FXa) defined as 0.2 IU/mL and 0.3 IU/mL, respectively. Low-VTE-risk threshold was achieved less often in NS-FD than C-FD group (91 vs. 62%, p = 0.024), while the high-VTE-risk threshold more often in NS-AD than in NS-FD group (90 vs. 38%, p < 0.001). Two VTE were observed in NS during 12 months of follow-up (incidence: 5.88%/year). In both cases anti-FXa were 0.3 IU/mL implying the use of anti-FXa >0.3 IU/mL as a target for dose-adjustment logistic regression models. We determined the optimal dose/IBW cut-off value at 0.8 mg/kg and further developed bivariate model (termed the DoAT model) including dose/IBW and antithrombin activity that improved the diagnostic accuracy (AUC 0.85 ± 0.06 vs. AUC 0.75 ± 0.08). Enoxaparin efficacy is reduced in severe NS and the dose should be adjusted to ideal body weight to achieve target anti-FXa activity.

Chemotherapy Dose Adjustment For Obese Patients Undergoing Hematopoietic Stem Cell Transplantation (HSCT): A Survey On Behalf Of The ALWP Of The EBMT

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4535-4535
Author(s):  
Noga Shem-Tov ◽  
Myriam Labopin ◽  
Leila Moukhtari ◽  
Fabio Ciceri ◽  
Jordi Esteve ◽  
...  
Keyword(s):  
Body Weight ◽  
Actual Body ◽  
Dose Adjustment ◽  
Ideal Body Weight ◽  
High Dose ◽  
Obese Patients ◽  
Actual Body Weight ◽  
Hematopoietic Stem ◽  
Chemotherapy Dose ◽  
Ideal Body

Rates of obesity have substantially increased in recent years. Pharmacokinetics of drugs including chemotherapy is different in obese patients due to alteration in the clearance and volume of distribution. Thus, appropriate chemotherapy dosing for obese patients with malignant diseases is a significant issue. Limiting chemotherapy doses in overweight and obese patients may negatively influence the outcomes in these patients. ASCO has recently published clinical practice guidelines for conventional chemotherapy dosing for obese patients with cancer indicating that up to 40% of obese patients received reduced chemotherapy doses that are not based on actual body weight (ABW) [Grigg A, JCO 2012]. Concerns about toxicity or overdosing in obese patients, based on the use of ABW, are unfounded. Moreover, there is a paucity of information addressing the pharmacokinetics of high dose chemotherapy in obese patients undergoing hematopoietic stem cell transplantation (HSCT). A rather small international survey of drug dosing schemes among transplant centers revealed that there is no consensus regarding appropriate dose adjustment for obese patients [Grigg A, Leuk Lymphoma 1997]. Also, there is limited data on outcomes in obese versus non-obese patients in various small retrospective studies. For this reason, the ALWP of the EBMT constructed an electronic survey for assessing current practice of dose adjustment of chemotherapy in patients undergoing HSCT, in transplant centers and for planning retrospective analysis and prospective studies in the future. Fifty six EBMT centers from 27 countries filled the online survey. Among the 56 centers, the percentage of obese patients was less than 10% in 22 centers (40%), between 10 to 19% in 23 centers (42%) and more than 20% in 10 centers (17%). Forty five centers declared they adjust chemotherapy dose for obese patients (80.5%) and only 11 (19.5%) declared they do not adjust dose. Among centers which adjust dose, most uses BMI as the parameter for defining obesity (28 centers, 62%), others use percentage over the actual body weight (ABW) as the basis for defining obesity (11 centers, 24.5%), both BMI and ABW (3 centers, 6.7%) or other parameter (3 centers, 6.7%). Most of the centers that use BMI for adjusting dose define BMI > 30 kg/m2 as the cut-off value (formal definition for obesity), only one center uses morbid obesity (BMI > 40 kg/m2), and the remainder uses other cut-off values. Among 11 centers who use ABW, 9 use ABW more than 120% of ideal body weight for adjustment. Eighty four percents of the centers use one level of obesity for adjustment while the rest uses 2 levels. The method for determining the weight for chemotherapy calculation was actual body weight (ABW) in 16 centers, ideal body weight (IBW) in 10 centers, IBW + 25% of difference between IBW and ABW (IBW+0.25*(ABW-IBW)) in 16 centers and other methods in the rest. Among centers that use dose adjustment, 44% also cap the dose at 2 m2 for chemotherapy dose based on BSA while 56% do not cap. On the contrary, most of the centers (9/11) that do not adjust dose for weight also do not cap the BSA at 2 m2. Seventy nine percents of responding centers use the same approach to dose adjustments for myeloablative, reduced intensity (RIC) or non myeloablative (NMA) conditioning, while 21% reduce the dose less for RIC or NMA conditioning. For Busulfan dose only 7 centers monitor pharmacokinetics (pk). Eleven centers use ideal body weight for calculation, 17 centers use actual weight and 18 centers correct weight according to percentage over actual body weight. Conclusion This EBMT survey reveal large diversity among transplant centers regarding dose adjustment practice for high dose conditioning chemotherapy. Most of the EBMT centers use dose adjustment for obese patients and about half of them also cap BSA at 2 m2, while capping is uncommon in the centers that do not adjust dose. Thus, the range of the final dose is very wide. Even for Busulfan where dose is calculated normally according to ideal body weight, the diversity of dose given for obese patients is wide. Our next step is to analyze outcomes of transplantation according to dose adjustment practice and subsequently to formulate a methodology for future prospective studies. Disclosures: No relevant conflicts of interest to declare.

Effect of a High Protein Diet in Patients with the Nephrotic Syndrome

1989 ◽  
Vol 77 (4) ◽  
pp. 445-451 ◽  
Author(s):  
H. Mansy ◽  
T. H. J. Goodship ◽  
J. S. Tapson ◽  
G. H. Hartley ◽  
Pauline Keavey ◽  
...  
Keyword(s):  
Body Weight ◽  
Nephrotic Syndrome ◽  
Plasma Renin Activity ◽  
Ideal Body Weight ◽  
Plasma Renin ◽  
Serum Phosphate ◽  
Renin Activity ◽  
Protein Diet ◽  
Dietary History ◽  
Ideal Body

1. Twelve patients with the nephrotic syndrome were prescribed for 4 week periods a normal protein diet (NPD) containing 1 g of protein/kg ideal body weight. They were then prescribed for further 4 week periods in random order diets with high (HPD) and low (LPD) protein contents, respectively 2.0 and 0.5 g/kg ideal body weight. 2. Compliance was confirmed by dietary history and measurement of urinary urea excretion. 3. Serum albumin was the same on all diets. Twenty-four hour urinary protein excretion increased progressively with increasing dietary protein (LPD 6.1 g, NPD 8.2 g, HPD 9.2 g). Recumbent plasma renin activity and serum phosphate were significantly increased on HPD (plasma renin activity: LPD 5.7, NPD 4.6, HPD 8.2 pmol of angiotensin I min−1 I−1; serum phosphate: LPD 1.27, NPD 1.26, HPD 1.41 mmol/l). 4. There was no evidence of protein-induced hyperfiltration or hyperperfusion: 51Cr-ethylenediaminetetraacetate and [125I]iodohippurate clearances were similar on all three diets. 5. Since proteinuria, increased plasma renin levels and hyperphosphataemia may contribute to progression of renal failure and because HPD did not improve hypoalbuminaemia, the use of HPD in the nephrotic syndrome should be abandoned. 6. Until it can be established that LPD, which is accompanied by the least proteinuria, does not, with long-term feeding, lead to malnutrition, NPD should be used in the treatment of the nephrotic syndrome.

Is Melphalan Dose Adjustment According to Ideal Body Weight Useful in Isolated Limb Infusion for Melanoma?

2012 ◽  
Vol 19 (9) ◽  
pp. 3050-3056 ◽  
Author(s):  
Anna M. Huismans ◽  
Hidde M. Kroon ◽  
Lauren E. Haydu ◽  
Peter C. A. Kam ◽  
John F. Thompson
Keyword(s):  
Body Weight ◽  
Dose Adjustment ◽  
Ideal Body Weight ◽  
Ideal Body

Determining Ideal Body Weight (and Mass)

1983 ◽  
Vol 40 (10) ◽  
pp. 1622-1627 ◽  
Author(s):  
Alan W. Hopefl ◽  
Donald R. Miller ◽  
James D. Carlson ◽  
Beverly J. Lloyd ◽  
Brian Jack Day ◽  
...  
Keyword(s):  
Body Weight ◽  
Ideal Body Weight ◽  
Ideal Body

scholarly journals Dosing of neuromuscular blocking agents in patients with obesity: A narrative review

2021 ◽  
pp. 0310057X2096857
Author(s):  
Brian L Erstad ◽  
Jeffrey F Barletta
Keyword(s):  
Body Weight ◽  
Ideal Body Weight ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Patient Specific ◽  
Lean Body Weight ◽  
Short Term ◽  
Blocking Agents ◽  
Ideal Body ◽  
Size Descriptor

There is no consensus on which weight clinicians should use for weight-based dosing of neuromuscular blocking agents (NMBAs), as exemplified by differing or absent recommendations in clinical practice guidelines. The purpose of this paper is to review studies that evaluated various size descriptors for weight-based dosing of succinylcholine and non-depolarising NMBAs, and to provide recommendations for the descriptors of choice for the weight-based dosing of these agents in patients with obesity. All of the studies conducted to date involving depolarising and non-depolarising NMBAs in patients with obesity have assessed single doses or short-term infusions conducted in perioperative settings. Recognising that any final dosing regimen must take into account patient-specific considerations, the available evidence suggests that actual body weight is the size descriptor of choice for weight-based dosing of succinylcholine and that ideal body weight, or an adjusted (or lean) body weight, is the size descriptor of choice for weight-based dosing of non-depolarising NMBAs.

Effect of adrenaline infusion on fatty acid and glucose turnover in lean and obese human subjects in the post-absorptive and fed states

1991 ◽  
Vol 81 (5) ◽  
pp. 635-644 ◽  
Author(s):  
Alan A. Connacher ◽  
William M. Bennet ◽  
Roland T. Jung ◽  
Dennis M. Bier ◽  
Christopher C. T. Smith ◽  
...  
Keyword(s):  
Body Weight ◽  
Energy Expenditure ◽  
Human Subjects ◽  
Ideal Body Weight ◽  
Glycerol Release ◽  
Fed State ◽  
Adrenaline Infusion ◽  
Obese Subjects ◽  
Ideal Body ◽  
Obese Human

1. Energy expenditure, plasma glucose and palmitate kinetics and leg glycerol release were determined simultaneously both before and during adrenaline infusion in lean and obese human subjects. Seven lean subjects (mean 96.5% of ideal body weight) were studied in the post-absorptive state and also during mixed nutrient liquid feeding, eight obese subjects (mean 165% of ideal body weight) were studied in the post-absorptive state and six obese subjects (mean 174% of ideal body weight) were studied during feeding. 2. Resting energy expenditure was higher in the obese subjects, but the thermic response to adrenaline, both in absolute and percentage terms, was similar in lean and obese subjects. Plasma adrenaline concentrations attained (3 nmol/l) were comparable in all groups and the infusion had no differential effects on the plasma insulin concentration. Before adrenaline infusion the plasma glucose flux was higher in the obese than in the lean subjects in the fed state only (45.8 ± 3.8 versus 36.6 ± 1.0 mmol/h, P <0.05); it increased to the same extent in both groups with the adrenaline infusion. 3. Before the adrenaline infusion plasma palmitate flux was higher in the obese than in the lean subjects (by 51%, P <0.01, in the post-absorptive state and by 78%, P <0.05, in the fed state). However, there was no significant change during adrenaline infusion in the obese subjects (from 13.5 ± 1.00 to 15.0 ± 1.84 mmol/h, not significant, in the post-absorptive state and from 14.4 ± 2.13 to 15.7 ± 1.74 mmol/h, not significant, in the fed state), whereas there were increases in the lean subjects (from 8.93 ± 1.10 to 11.2 ± 1.19 mmol/h, P <0.05, in the post-absorptive state, and from 8.06 ± 1.19 to 9.86 ± 0.93 mmol/h, P <0.05, in the fed state). 4. Before adrenaline infusion the palmitate oxidation rate was also higher in the obese than in the lean subjects (1.86 ± 0.14 versus 1.22 ± .09 mmol/h, P <0.01, in the post-absorptive state and 1,73 ± 0.25 versus 1.12 ± 0.12 mmol/h, P <0.05, in the fed state). However, in response to adrenaline the fractional oxidation rate (% of flux) increased less in the obese than in the lean subjects, especially in the post-absorptive state (from 13.8 ± 1.02 to 14.9 ± 1.39%, not significant, versus from 13.7 ± 0.98 to 19.3 ± 1.92%, P <0.05). These effects were independent of feeding. Leg glycerol release increased more in the lean subjects with adrenaline infusion, although increases in the plasma glycerol concentration did not differ between the groups. 5. These results suggest that in obese subjects plasma inter-organ transport of fatty acids and the subsequent fractional oxidation responses favour storage of triacylglycerol. These factors may be important determinants for the development and maintenance of the obese state.

Weight and Menstrual Function in Patients with Eating Disorders and Cystic Fibrosis

PEDIATRICS ◽  
1992 ◽  
Vol 89 (3) ◽  
pp. 522-522
Author(s):  
ALBERT C. HERGENROEDER
Keyword(s):  
Cystic Fibrosis ◽  
Eating Disorders ◽  
Body Weight ◽  
Growth Curves ◽  
Ideal Body Weight ◽  
Menstrual Function ◽  
Ideal Body ◽  
The Ideal

To the Editor.— This letter is in response to the article entitled "Weight and Menstrual Function in Patients with Eating Disorders and Cystic Fibrosis."1 Under "Methods," the authors describe a method for calculating percent ideal body weight by plotting the patient's height on standard growth curves derived from the data of Hamill et al,2 and the ideal body weight being the weight at the same percentile for age. Using the tables of Hamill to calculate percentages of height and weight for females older than 10 years and males older than 11½ years should be done cautiously.

Body Shaping Through Aerobic Training in the Gym in Adult Women

2020 ◽  
Vol 65 (4) ◽  
pp. 97-107
Author(s):  
Alexandra Giurgiu ◽  
Iacob Hanțiu
Keyword(s):  
Body Weight ◽  
Physical Training ◽  
Aerobic Training ◽  
Ideal Body Weight ◽  
The Body ◽  
Adult Women ◽  
Hip Circumference ◽  
Positive Effects ◽  
Ideal Body ◽  
Training Exercises

ABSTRACT. Introduction. Regular physical activity has positive effects on human body composition, even if not combined with a diet. For many people this activity aims to reduce the amount of fat in some areas of the body and targets body shaping. Objectives. The main objective of this study was to learn about the effects of a 12-months regular participation in aerobic training exercises. Methods. This study was voluntarily attended by 89 women with an average age of 31.62, practicing aerobic exercises in gyms, three times a week for a period of 12 months. We carried out anthropometric measurements of subjects at the beginning and at end of the study, respectively, and data was statistically analysed using the SPSS 23.0 software. Results. Data collected was statistically processed, showing that participation in physical training led to reducing body weight by 4.81 kg, decrease of adipose tissue - between the two moments there was a difference of 5 % - fat mass decreased by 4.26 kg, and lean body mass by 0.55 kg. Significant decrease in chest, waist and hip circumference was also noticed. Conclusions. Regular participation in physical training programs involving aerobic exercise for 12 months has had the effect of reducing body weight and the amount of fat in some areas of the body, materialized by decreasing the value of the circumference of the chest, waist and hips, with the intention of reaching the ideal body weight and aiming for body shaping.

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