scholarly journals Dimethylarginines in Children after Anti-Neoplastic Treatment

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 108
Author(s):  
Michalina Jezierska ◽  
Anna Owczarzak ◽  
Joanna Stefanowicz
Keyword(s):  
Renal Function ◽  
Cystatin C ◽  
Urine Analysis ◽  
Childhood Cancer Survivors ◽  
Paediatric Population ◽  
Urea Nitrogen ◽  
Group 3 ◽  
Medical Histories ◽  
Tract Infections ◽  
Group 1

Background and Objectives: According to a recent Cochrane systematic review, renal impairment can develop in 0–84% of childhood cancer survivors in the future. The renal function impairment in this patient group can be related to nephrectomy, nephrotoxic agents therapy, abdominal radiotherapy, and combinations of these treatment methods. In this study, in a population of patients after anti-neoplastic therapy, with particular emphasis on patients after Wilms’ tumour treatment, we compared new substances which play role in the chronic kidney disease (CKD) pathogenesis (asymmetric dimethylarginine—ADMA, symmetric dimethylarginine—SDMA) with standard renal function markers (e.g., creatinine and cystatin C in serum, creatinine in urine, etc.) to assess the usefulness of the former. Materials and Methods: Eighty-four children, without CKD, bilateral kidney tumours, congenital kidney defects, or urinary tract infections, with a minimum time of 1 year after ending anti-neoplastic treatment, aged between 17 and 215 months, were divided into three groups: group 1—patients after nephroblastoma treatment (n = 21), group 2—after other solid tumours treatment (n = 44), and group 3—after lymphoproliferative neoplasms treatment (n = 19). The patients’ medical histories were taken and physical examinations were performed. Concentrations of blood urea nitrogen (BUN), creatinine, cystatin C, C-reactive protein (CRP), ADMA, and SDMA in blood and albumin in urine were measured, and a general urine analysis was performed. The SDMA/ADMA ratio, albumin–creatine ratio, and estimated glomerular filtration rate (eGFR) were calculated. eGFR was estimated by three equations recommended to the paediatric population by the KDIGO from 2012: the Schwartz equation (eGFR1), equation with creatinine and urea nitrogen (eGFR2), and equation with cystatin C (eGFR3). Results: Both the eGFR1 and eGFR2 values were significantly lower in group 1 than in group 3 (eGFR1: 93.3 (83.1–102.3) vs. 116.5 (96.8–126.9) mL/min/1.73 m2, p = 0.02; eGFR2: 82.7 (±14.4) vs. 94.4 (±11.9) mL/min/1.73 m2, p = 0.02). Additionally, there were weak positive correlations between SDMA and creatinine (p < 0.05, r = 0.24), and cystatin C (p < 0.05, r = 0.32) and weak negative correlations between SDMA and eGFR1 (p < 0.05, r = −0.25), eGFR2 (p < 0.05, r = −0.24), and eGFR3 (p < 0.05, r = −0.32). Conclusions: The usefulness of ADMA and SDMA in the diagnosis of renal functional impairment should be assessed in further studies. eGFR, calculated according to equations recommended for children, should be used in routine paediatric practice.

The Main Determinants of Serum Resistin Level in Type 2 Diabetic Patients are Renal Function and Inflammation not Presence of Microvascular Complication, Obesity and Insulin Resistance

2018 ◽  
Vol 127 (04) ◽  
pp. 189-194 ◽  
Author(s):  
Egemen Cebeci ◽  
Cengiz Cakan ◽  
Meltem Gursu ◽  
Sami Uzun ◽  
Serhat Karadag ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Renal Function ◽  
Microvascular Complications ◽  
Resistin Level ◽  
Group 3 ◽  
Group 2 ◽  
Main Determinants ◽  
Hs Crp ◽  
Group 1

Abstract Aim The association of increased resistin levels in chronic kidney disease with diabetic nephropathy has not yet been clarified. Our aim was to analyze the relationship between serum resistin levels and various diabetic microvascular complications in patients. Methods A total of 83 patients were enrolled in this cross-sectional study. The subjects were divided into 3 groups: 27 patients with type 2 diabetes mellitus (T2DM) having no diabetic retinopathy (DRP) or microalbuminuria and having normal renal function were included in Group-1, 28 patients with T2DM having DRP and normal renal function in Group-2, and 28 patients with T2DM with DRP and microalbuminuria and an estimated glomerular filtration rate (eGFR) of<60 ml/min/1.73 m2 in Group-3. Serum resistin levels were analyzed by enzyme-linked immunosorbent assay. Results The mean age of the patients [46 female (55.4%)] was 54.8±9.1 years. The resistin level in Group-3 was significantly higher than in Group-1 and Group-2 (p<0.001).However the resistin level was not different between Group-1 (without microvascular complications) and Group-2 (with microvascular complications). The resistin level was found to be correlated negatively with eGFR (r=−0.459; p<0.001) and albumin (r=−0.402; p<0.001), and positively with high-sensitivity C-reactive protein (hs-CRP) (r=0.366; p=0.001). In multivariate analysis, it was observed that eGFR and hs-CRP were independent determinants of plasma resistin level. Conclusion The main determinants of resistin level in patients with T2DM are the level of renal function and inflammation rather than presence of microvascular complications, obesity and insulin resistance.

scholarly journals Impact of Renal Function on Long-Term Clinical Outcomes in Patients With Coronary Chronic Total Occlusions: Results From an Observational Single-Center Cohort Study During the Last 12 Years

2020 ◽  
Vol 7 ◽  
Author(s):  
Lei Guo ◽  
Huaiyu Ding ◽  
Haichen Lv ◽  
Xiaoyan Zhang ◽  
Lei Zhong ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Insufficiency ◽  
Clinical Outcomes ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background: The number of coronary chronic total occlusion (CTO) patients with renal insufficiency is huge, and limited data are available on the impact of renal insufficiency on long-term clinical outcomes in CTO patients. We aimed to investigate clinical outcomes of CTO percutaneous coronary intervention (PCI) vs. medical therapy (MT) in CTO patients according to baseline renal function.Methods: In the study population of 2,497, 1,220 patients underwent CTO PCI and 1,277 patients received MT. Patients were divided into four groups based on renal function: group 1 [estimated glomerular filtration rate (eGFR) ≥ 90 ml/min/1.73 m2], group 2 (60 ≤ eGFR &lt;90 ml/min/1.73 m2), group 3 (30 ≤ eGFR &lt;60 ml/min/1.73 m2), and group 4 (eGFR &lt;30 ml/min/1.73 m2). Major adverse cardiac event (MACE) was the primary end point.Results: Median follow-up was 2.6 years. With the decline in renal function, MACE (p &lt; 0.001) and cardiac death (p &lt; 0.001) were increased. In group 1 and group 2, MACE occurred less frequently in patients with CTO PCI, as compared to patients in the MT group (15.6% vs. 22.8%, p &lt; 0.001; 15.6% vs. 26.5%, p &lt; 0.001; respectively). However, there was no significant difference in terms of MACE between CTO PCI and MT in group 3 (21.1% vs. 28.7%, p = 0.211) and group 4 (28.6% vs. 50.0%, p = 0.289). MACE was significantly reduced for patients who received successful CTO PCI compared to patients with MT (16.7% vs. 22.8%, p = 0.006; 16.3% vs. 26.5%, p = 0.003, respectively) in group 1 and group 2. eGFR &lt; 30 ml/min/1.73 m2, age, male gender, diabetes mellitus, heart failure, multivessel disease, and MT were identified as independent predictors for MACE in patients with CTOs.Conclusions: Renal impairment is associated with MACE in patients with CTOs. For treatment of CTO, compared with MT alone, CTO PCI may reduce the risk of MACE in patients without chronic kidney disease (CKD). However, reduced MACE from CTO PCI among patients with CKD was not observed. Similar beneficial effects were observed in patients without CKD who underwent successful CTO procedures.

scholarly journals Effect of Renal Function on Success and Complications of Percutaneous Nephrolithotomy

2021 ◽  
pp. 68-73
Author(s):  
Serkan Yarimoglu ◽  
Mehmet Erhan Aydin ◽  
Murat Sahan ◽  
Omer Koras ◽  
Onur Erdemoglu ◽  
...  
Keyword(s):  
Renal Function ◽  
Glomerular Filtration ◽  
Percutaneous Nephrolithotomy ◽  
Kidney Stones ◽  
Complication Rates ◽  
Number Of Patients ◽  
Group 3 ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Objective: In this study, we aimed to compare the success and complication rates of percutaneous nephrolithotomy (PCNL) according to preoperative glomerular filtration rates (GFR) of patients who underwent PCNLdue to kidney stones. Material and Methods: Between January 2012 and December 2016, 794 patients who underwent PCNL due to kidney Stones were evaluated retrospectively. Preoperative GFR values of patients were calculated according to Cockcroft –Gault formula. The patients with preoperative GFR values>90 ml/min, 60-90 ml/min, 30-60 ml/min were respectively defined as group-1, group-2 and group-3. Preoperative and perioperative values, Stone free rates and complication rates were compared between the groups. Postoperatively , <4 mm residual stone was identified as success. Results: There were 466 patients in Group-1, 259 in Group-2 and 67 patients in Group-3. The mean preoperative GFR values of the patients were 118.53 ml/min, 77.76 ml/min and 48.52 ml/min, respectively in group-1, group-2 and group-3 (p <0.001).The mean age of the patients was 62.8±11.47, 51.86±11.10, and60.31±12.7, respectively, in group-1, group-2 and group-3 (p<0.001).The mean Stone burden of the patients were 497.34±518.60 mm2, 517.6±493.8 mm2and 711.06±679.07 mm2, respectively, in group-1, group-2 and group-3 (p=0.013). The number of patients identified with success after surgery was 355 (86.2%), 195 (76.1%) and 50 (74.6%) in group-1, group-2 and group-3, respectively (p = 0.542). The number of patients who develop complications was 114 (%24.65), 57 (%22) and 11 (%16.4) in group-1, group-2 and group-3, respectively (p=0.310). Conclusion: Preoperative GFR valuesare not lonely sufficient to predict success and complications after PCNL. Keywords: Percutaneous nephrolithotomy, renal function, renal stone, glomerular filtration rates

scholarly journals P330 Blunted heart rate reserve during vasodilator stress echocardiography in diabetic and renal failure patients

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Bellino ◽  
D Ferraro ◽  
A Silverio ◽  
A P Peluso ◽  
L Soriente ◽  
...  
Keyword(s):  
Heart Rate ◽  
Renal Failure ◽  
Renal Function ◽  
Autonomic Dysfunction ◽  
Wall Motion ◽  
Beta Blockers ◽  
Cardiac Autonomic Dysfunction ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Funding Acknowledgements None Background A blunted heart rate reserve (HRR) during dipyridamole stress echo (SE) is a marker of cardiac autonomic dysfunction associated with poor outcome, independently of inducible ischemia, underlying coronary artery disease (CAD) and beta-blocker therapy. Patients with diabetes and/or renal failure have higher prevalence of underlying autonomic dysfunction. Aim. To assess the value of HRR in patients undergoing dipyridamole SE. Methods We prospectively recruited a sample of 61 patients with known or suspected CAD (mean age 75 ± 10 years; 34 males, 55,7%; 50% on beta-blockers at the time of testing). Coexistent atrial fibrillation or previous pacemaker implantation were considered as exclusion criteria. Three groups were identified a priori: non-diabetic with normal renal function (n = 43, Group 1); diabetics, with normal renal function (n = 14, Group 2); severely impaired renal function on dialysis (n = 4, Group 3). All patients underwent dipyridamole SE (0.84 mg/kg in 10"). Wall motion score Index (WMSI) was calculated with a 17-segment score of left ventricle, each segment scored from 1= normal to 4= dyskinetic. HRR was measured by ECG as the peak/rest HR ratio. Results A positive SE (stress WMSI&gt; rest WMSI) was present in 2 patients of Group 1 (4.7%), 4 of Group 2 (28.6%) and no patient in Group 3. Heart rate was different, although not significant, among the 3 groups both at rest (66.1 ± 11.1 vs 64.6 ± 8.5 vs 79.0 ± 8.0, p = 0.050) and at peak stress (83.8 ± 12.6 vs 75.3 ± 10.3 vs 86.5 ± 11.1, p = 0.059). Of note, HRR was statistically different among groups (1.29 ± 0.20 vs 1.19 ± 0.14 vs 1.09 ± 0.06, p &lt; 0.047; see figure). There was no difference in HRR between patients off and on-beta-blockers (1.19 ± 0.16 vs 1.24 ± 0.24, p = 0.421) and with or without positive SE (1.20 ± 0.14 vs 1.25 ± 0.20, p = 0.530). Overall, HRR ≤ 1.17 (median value) was reported in 39.5% of Group 1, 71.4% of Group 2, and 100% of Group 3 pts (p = 0.024). No significant correlations between HRR and peak WMSI (p = 0.183) or age (0.062) were reported. Conclusion HRR is frequently abnormal in patients referred for SE testing, especially in presence of concomitant diabetes and advanced renal failure. The blunted chronotropic response is a simple, imaging independent marker of cardiac autonomic dysfunction and may usefully complement the conventional evaluation with regional wall motion abnormalities during vasodilator SE. Abstract P330 Figure title: HRR box plots

scholarly journals Renovasal relationship in patients with uncomplicated hypertensive disease

2019 ◽  
Vol 36 (4) ◽  
pp. 5-12
Author(s):  
A. I. Chernyavina ◽  
N. A. Koziolova ◽  
S. V. Mironova
Keyword(s):  
Arterial Stiffness ◽  
Cystatin C ◽  
Normal Values ◽  
Hypertensive Disease ◽  
Arterial Lesion ◽  
Group 3 ◽  
The Mean ◽  
Group 2 ◽  
Level Group ◽  
Group 1

Aim. To assess the influence of arterial stiffness on the renal filtration function in patients with uncomplicated hypertensive disease. Materials and methods. The study included 88 patients of able-bodied age, suffering from stage III hypertensive disease. The mean age was 50.38 5.19 years. All the patients underwent sphigmopletismography with assessment of cardio-malleolar-vascular index (CAVI1), evaluation of renal filtration function by creatinine and cystatin C levels as well as by calculated glomerular filtration rate (GFR) by creatinine and cystatin C. All the patients were divided into 3 groups according to CAVI1 level: group 1 patients without arterial lesion and CAVI1 8; group 2 patients with borderline changes in arteries and CAVI1 8.08.9; group 3 patients with arterial lesion and CAVI19. Results. No statistically significant differences by clinicoanamnestic characteristics were found out in patients of all groups. In patients of group 1, cystatin level appeared to be statistically significantly lower than in patients of group 2 and 3 (pmg = 0.013). Patients of all groups statistically significantly differed according to GFR by cystatin C (pmg = 0.015). No difference according to creatinine level and GFR by creatinine were registered in the groups. Conclusions. As arterial stiffness by CAVI1 level is increased, there occurs statistically significant aggravation of renal filtration function, assessed by cystatin C level and GFR using the formula CKD-EPI by cystatin C. Changes in the renal filtration function indices were observed within the normal values that shows early preclinical changes.

scholarly journals Peculiarities of chronic heart failure formation in patients with persistent atrial fi brillation depending on the renal dysfunction phenotype

2020 ◽  
Vol 35 (2) ◽  
pp. 81-88
Author(s):  
E. A. Polyanskaya ◽  
N. A. Koziolova
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Renal Dysfunction ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Left Ventricular ◽  
Tubular Dysfunction ◽  
Collagen Formation ◽  
Group 3 ◽  
Group 1

Aim. To study the features of chronic heart failure (CHF) formation in patients with persistent atrial fibrillation (AF) depending on the phenotype of renal dysfunction.Material and Methods. The study included 60 patients with persistent AF and CHF. To diagnose CHF, echocardiography study was performed and the concentrations of NT-pRoBNP and sST2 in the blood serum were determined. Renal filtration function was assessed by glomerular filtration rate (GFR) calculated based on creatinine and cystatin C. Plasma NGAL concentration was determined to assess tubular dysfunction. Three phenotypes of renal damage were identified. Group 1 included 14 individuals (23.3%) with isolated tubular dysfunction assessed by NGAL; group 2 included 14 patients (23.3%) with isolated glomerular dysfunction assessed by GFR (CKD-EPIcys); group 3 comprised 32 patients (53.3%) with a combination of tubular and glomerular dysfunction.Results. The GFR value (CKD-EPIcre) below 60 mL/min/1.73 m2 was found in 36.7% of patients from groups 2 and 3. The concentration of cystatin C significantly diff ered between groups and was the highest in group 3. The value of GFR (CKDEPIcys) below 60 mL/min/1.73 m2 was detected in 76.7% of patients from all groups. The value of GFR (CKD-EPIcys) significantly diff ered between groups and was the lowest in group 3. When comparing serum creatinine and cystatin C in group 1, eight patients (57.1%) showed latent glomerular dysfunction, which manifested only in the concentration of cystatin C. A relationship was found between the level of DBP and NGAL (r = 0.44; p < 0.05). The correlations were identified between the parameters of left ventricular (LV) diastolic function and indicators of filtration function and tubular apparatus of the kidneys, namely: between E/e’ and NGAL concentration (r = 0.31; p < 0.05); between E/e’ and cystatin C concentration (r = 0,30; p < 0.05); between E/A and NGAL concentration (r = –0.36; p < 0.05); and between septal e’ and cystatin C concentration (r = –0.30; p < 0.05). Relationships were found between the concentrations of NGAL and sST2 (r = 0.44; p < 0.05) and between the concentrations of cystatin C and TIMP-1 (r = 0.39; p < 0.05).Conclusion. The use of blood cystatin C to assess kidney filtration function allowed to detect latent glomerular dysfunction in 57.1% of patients with heart failure and persistent AF, which could not be determined by GFR (CKD-EPIcre). Patients with persistent AF developed CHF with preserved LV EF regardless of the phenotype of renal dysfunction. The severities of glomerular filtration and kidney tubular apparatus abnormalities correlated with the severity of diastolic dysfunction. Unlike clinical indicators and blood concentration of NT-proBNP, sST2 levels allowed to detect the diff erences in heart failure severity in patients with persistent AF depending on the phenotype of renal dysfunction: the lowest severity was observed in the presence of glomerular dysfunction; the highest severity was found in the presence of combined dysfunction. Glomerular dysfunction in patients with CHF and persistent AF was associated with the impaired collagen formation and TIMP-1 activation. 

Empirical Vs. Prophylactic Antifungal Strategies: Comparison of Effectiveness In High Risk AML Patients at a Tertiary Cancer Center

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1729-1729
Author(s):  
Dennis Gutmann ◽  
Jan Felix Kersten ◽  
Philippe Schafhausen ◽  
Tim H. Brummendorf ◽  
Martin Trepel ◽  
...  
Keyword(s):  
High Risk ◽  
Fungal Infections ◽  
Empirical Therapy ◽  
Primary Prophylaxis ◽  
Cancer Center ◽  
Group 3 ◽  
Group 2 ◽  
Tract Infections ◽  
Tertiary Cancer Center ◽  
Group 1

Abstract Abstract 1729 Objectives: Invasive fungal infections (IFI) remain a major threat for patients with acute myelogenious leukemia (AML). Since the publication of two landmark studies, which demonstrated a reduction in morbidity and mortality from IFI in high risk patients through prophylaxis with posaconazole, guidelines have recommend routine prophylaxis with posaconazole during induction chemotherapy. However, prompt empirical or pre-emptive therapy strategies are still commonly used alternatives. Real life data about posaconazole prophylaxis are scarce and potential overtreatment, increasing costs and development of resistant fungi are of concern. We therefore compared effectiveness of empirical and prophylactic antifungal strategies at a tertiary cancer center during a phase of intensive building (re-) construction Methods: 104 patients (pts.) with AML treated between January 2005 and February 2009 were retrospectively evaluated. Each induction chemotherapy or consolidation therapy with neutropenia >=10 days was counted as an episode (n=222). Patients were stratified according to their antifungal approach: primary prophylaxis (n=35, 51 episodes; group 1), empirical therapy (n=63, 111 indices; group 2), secondary prophylaxis (n=41, 60 episodes; group 3, which comprised of patients from groups 1 and 2). Group 1 received posaconazole 3 × 200 mg p.o.; group 2 received topical polyene prophylaxis and empirical treatment with voriconazole or fluconazole. Patients in group 3 received either voriconazole, posaconazole, fluconazole or intraconazole. Results: Demographics, AML subtypes, co-morbidities and neutropenic days (median = 13) were comparable in all three groups; no patient received G-CSF support. Logistic regression analysis revealed days of neutropenia, performance status, use of antibiotics and secondary AML as risk factors for development of IFI, while primary prophylaxis reduced the risk for possible/probable/proven IFI by 86,7% compared to empirical therapy (p=0.001). Incidences of probable/proven IFI were 3% in group 1, 29% in group 2 and 7% in group 3 (p=0.001) and 17%, 69% and 37% (p<0.001) when possible IFIs were included. Mortality during observation period was similar (4%, 6,4%, 7%, NS). Also similar were isolated pathogens, additional antifungals, change of antibiotics, days at intensive care unit (ICU). Bacterial infections were similiar in all groups except for pneumonia and GI-tract infections being significantly higher in pts with empirical antifungal therapy. Side effects were also slightly higher in this group (8% vs 2% and 5%, NS). Days of hospitalization, antifungal, antibiotic, and antiviral costs were comparable, while imaging costs were significantly higher in group 2 (p=0.006). Conclusion: Posaconazole prophylaxis significantly reduces incidences of IFI in high risk AML patients and leads to a reduction of costs for imaging studies, with a minimal overall reduction of costs for inpatients. Additionally, infectious complications such as pneumonia and GI-tract infections are also reduced, while mortality rates, days of hospitalization, anti-infective use or duration are not reduced. Accordingly, in areas/surroundings with high rates of fungal infections (e.g. due to intensive building (re-)construction), primary prophylaxis with posaconazole is recommended. Disclosures: Brummendorf: Pfizer: Membership on an entity's Board of Directors or advisory committees. Panse:Gilead: Honoraria; Schering-Plough: Honoraria; MSD: Travel Grant.

Pharmacokinetics, Efficacy and Safety of Lenalidomide (Len) in Myeloma Patients with Renal Impairment: Results From the Prospective Study “REVIR”

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2934-2934 ◽  
Author(s):  
Frank Bridoux ◽  
Bertrand Arnulf ◽  
Stephane Moreau ◽  
Eric Moumas ◽  
Nianhang Chen ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Impairment ◽  
Prospective Study ◽  
Efficacy And Safety ◽  
Group 4 ◽  
Starting Dose ◽  
Group 3 ◽  
Group 5 ◽  
Highly Correlated ◽  
Group 1

Abstract Abstract 2934 Introduction: Len combined with Dexamethasone (Dex) is becoming a standard treatment in multiple myeloma (MM). As Len is mainly excreted by the kidneys, its dose should be adjusted according to renal function. Current dosing recommendations are based on a study conducted in non-malignant patients (pts) and on modelling/simulations. To assess whether these recommendations are actually valid in MM pts, we conducted a prospective study evaluating pharmacokinetics (PK), safety and efficacy of Len+Dex in pts with various degrees of renal impairment (RI). We also compared the glomerular filtration rate (GFR) estimated either by the Modification of Diet in Renal Disease (MDRD) dosage (GFR/MDRD) or by the Cockroft and Gault (CG) equation (GFR/CG) for determining Len dosage. Methods: 37 Caucasian pts (median age 65 yrs) with symptomatic MM who had received ≥ 1 previous line of treatment, were enrolled. All had stable renal function over 4 weeks prior to inclusion. They were divided in 5 groups according to GFR/CG at baseline: group 1, > 80mL/min (N = 10); group 2, ≥ 50 & ≤ 80 mL/min (N = 10); group 3, ≥ 30 & < 50 mL/min (N = 7); group 4, < 30 mL/min (N = 5); group 5, chronic hemodialysis (N = 5). Cast nephropathy and light chain deposition disease were documented by kidney biopsy as the respective cause of RI in 6 and 1 of the 17 pts from groups 3, 4 and 5. Pt characteristics were similar, except for pts in group 4 who were significantly older (p = 0.01). All pts received ≥ 3 cycles of oral Len+Dex (40 mg weekly) regimen from Days 1–21 of each 28-day cycle. Len starting dose was defined according to the current dosing guideline, i.e.: group 1 and 2: 25 mg/d; group 3: 10 mg/d; group 4: 15 mg/qod; group 5: 5 mg/d. Blood samples were collected on a dosing day in the first cycle for PK analyses, as follows: at pre-dose, 0.5, 1, 1.5, 2, 4, 6, 8, 10, 24 h (and 36 and 48 h in groups 3–5) after the Len dose on day 5, and at predose and 2 h (near tmax) after the Len dose on days 9 and 15. Results: Len clearance was highly correlated to GFR/CG (R2 = 0.86, p < 0.001). Mean Len clearance declined from 239 mL/min in group 1, to 160, 93, 54, and 41 mL/min, and mean terminal half life was prolonged from 3 h to 5, 7, 10, and 24h in groups 2, 3, 4 and 5, respectively. These findings were consistent with those reported for pts with RI due to non-malignant conditions. The average daily AUC values for groups 2–5 were 103–149% of that for group 1 (1794 h*ng/mL). No difference was found in mean plasma Len concentrations at 2 h post-dose between day 9 (Len alone) and day 15 (Len+Dex) across groups. GFR/MDRD and GFR/CG were highly correlated (R2 = 0.85, slope = 0.89) and similarly predicted Len clearance (slope = 2.38 and 2.15, respectively). When the same cutoff values were used for GFR/MDRD and GFR/CG, the % reduction in Len clearance in groups 3–5 compared with the combined groups 1 and 2 was very similar for GFR/MDRD- and GFR/CG-based renal function classifications. However, a dosage discordance between GFR/MDRD and GFR/CG would occur in 5/32 non-dialysis pts. All the 5 pts would be assigned to a lower starting dose according to GFR/MDRD. The estimated resulting AUC levels would have been reduced to 68–94% of the mean AUC in group 1 from the observed 91–238%. These estimated AUC levels would be considered to be in the therapeutic range. After 3 cycles of Len+Dex, hematological response rate (≥ PR) was 73% (VGPR 27%). Response rates were 70% in pts with < 50ml/min. Renal function remained stable in all pts. A total of 22 serious (≥ grade 3) adverse events (SAEs), including 16 hematological SAEs, occurred in 12 pts, leading to dose reduction in 7 cases. Of these, 2 pts would have been assigned to a lower starting dose according to GFR/MDRD. The frequency of SAEs was not significantly increased in group 5 compared to the other groups (60% vs 45%, p = 0.3). After a median follow-up of 10 months, pts had received a mean number of 7.6 ± 4.3 cycles, and 5 had died, because of MM progression in 4 cases. Conclusion: The study demonstrated that the effect of RI on the Len PK in MM patients receiving concomitant Dex was similar to that in non-malignant pts receiving Len alone. The recommended dose adjustments achieved the appropriate plasma exposure with similar efficacy and safety across different renal function groups in MM pts. GFR/MDRD and GFR/CG may be interchangeable for determining the Len dosage. Disclosures: Chen: Celgene Corporation: Employment. Alakl:Celgene Corporation: Employment. Neel:Celgene Corporation: Employment. Jaccard:Celgene Corporation: Consultancy.

Frailty Score and Renal Function Impairment in Elderly Patients with Hypertension: A Correlation Study

2020 ◽  
Vol 10 (8) ◽  
pp. 1809-1814
Author(s):  
Jun Xie ◽  
Zeping Hu ◽  
Yuanyuan Sun ◽  
Linlin Yang
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Cystatin C ◽  
Diastolic Pressure ◽  
Pressure Variation ◽  
Control Group ◽  
Observation Group ◽  
Urea Nitrogen ◽  
Factors Affecting ◽  
Frailty Score

To explore the correlation between frailty score and renal function impairment of elderly patients with hypertension. A total of 124 patients admitted to the Hefei Hospital Affiliated to Anhui Medical University/Hefei Second People’s Hospital between October 2017 and January 2019 with hypertension complicated with frailty were included. Patients with hypertension were divided into the Observation Group and Control Group (62 patients each). The blood pressure variability rate, renal function, and frailty score were compared between the two groups. Furthermore, the correlation between frailty score and renal function index was analyzed. The variations in the 24-h systolic and 24-h diastolic blood pressure in the Observation Group were significantly higher than those in the Control Group (P < 0.05). Levels of cystatin C, homocysteine, urea nitrogen, creatinine, and uric acid were all higher in the Observation Group than in the Control Group, with the difference being statistically significant (P < 0.05). Meanwhile, no statistical difference was observed between urea nitrogen/creatinine and hypersensitive CRP (P > 0.05). Pearson partial correlation analyses showed that the weakness score was positively correlated with systolic pressure variation percentage, diastolic pressure variation percentage, homocysteine, cystatin C, creatinine, and urea nitrogen (P < 0.05). The scores of various dimensions of weakness obtained via further regression analyses showed that the scores of physical frailties were positively correlated with homocysteine and cystatin C (P < 0.05). Multivariate analysis showed that frailty score, percentage of diastolic blood pressure variation, and physical weakness were independent factors affecting cystatin C level (P < 0.05). The rate of blood pressure variability is higher and renal function damage is more common in elderly hypertension patients with frailty. Frailty score, percentage of diastolic pressure variation, and physical weakness were independent risk factors affecting renal function.

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