A retrospective analysis to estimate trough concentrations of teicoplanin in patients with suspected or documented Gram-positive infections

Abstract Teicoplanin is a glycopeptide antibiotic commonly used to treat Gram-positive bacterial infections in the clinic. The aim of this study was to provide a therapeutic reference for the clinical application and dosage regimen adjustment of teicoplanin by identifying factors associated with its plasma trough concentration (Ctrough). A retrospective study was performed on patients with suspected or documented Gram-positive infections who were hospitalized from November 2017 to January 2020 and treated with teicoplanin while undergoing routine therapeutic drug monitoring (TDM). A total of 112 Ctrough trough measurements were obtained from 72 patients were included in this study. SPSS software was used for correlation analysis and receiver operator characteristic curve (ROC) analysis. The Ctrough for teicoplanin showed statistically significant relationships (P<0.05) with PLT, Scr, CLcr, eGFR, BUN and Cys-C. ROC curve analysis revealed that CLcr and eGFR were more sensitive and specific for Ctrough compared to the other factors. These findings should be considered in the clinical application of teicoplanin and for its dosage adjustment.

Recomendaciones para evaluar la tasa de filtrado glomerular menor de 60 ml/min/1, 73 m2 en pacientes con enfermedad renal y diabetes mellitus / Recommendations to evaluate the glomerular filtration rate below 60 ml/min/1. 73 m2 in patients with kidney disease and diabetes

Diagnosticar, clasificar y estadificar la enfermedad renal en pacientes con diabetes mellitus (DM) es un desafío tanto para los médicos de atención primaria como para los especialistas, porque no existe método en la práctica clínica que evalúe la tasa de filtrado glomerular (TFG) en forma precisa. Para evaluar la función renal en enfermedad renal crónica (ERC) con menos de 60 ml/min/1.73m2 , correspondiente a los estadios 3, 4 y 5 de la clasificación actual, los métodos disponibles en los laboratorios clínicos son de limitada exactitud. En este trabajo se desarrollarán las condiciones que debería cumplir un marcador ideal, las dificultades que ofrece la evaluación de la creatinina, la medición de la TFG, así como las ventajas y limitaciones de las recomendaciones del uso de fórmulas para su determinación, y el algoritmo actual para estimar función renal. Conclusiones: actualmente, a pesar de las limitaciones, se recomienda el empleo de fórmulas para la estimación de la TFG, sobre todo en TFG menor a 60 ml/min/1.73 m2. Es un desafío, para un futuro mediato, desarrollar mejores recursos para su evaluación.

To diagnose,classify and stage diabetic kidney disease in patients with diabetes mellitus is a challenge in clinical practice for both primary care physicians and specialists because there is no method in clinical practice that evaluates accurately the glomerular filtration rate (GFR). This challenge is due to difficulties in evaluating kidney function in stages of chronic kidney disease (CKD) below 60 ml/min/1.73m2 corresponding to stages 3, 4 and 5 of the classification, because the available tools in clinical laboratories are of limited accuracy. This work explores the conditions that an ideal marker should meet, the difficulties offered by the evaluation of serum creatinine, the measurement of the glomerular filtration rate (GFR) as well as the advantages and limitations of the recommendations of the use of formulas for its determination and the current algorithm to estimate renal function. Conclusions: currently, despite the limitations, the use of formulas for the diagnosis of renal function is recommended, especially in GFR below 60 ml/min/1.73 m2. It is a challenge for the near future to develop better tools for the evaluation of TGF.

Recomendaciones para evaluar la tasa de filtrado glomerular menor de 60 ml/min/1,73 m2 en pacientes con enfermedad renal y diabetes mellitus / Recommendations to evaluate the glomerular filtration rate below 60 ml/min/1.73 m2 in patients with kidney disease and diabetes

Resumen Diagnosticar, clasificar y estadificar la enfermedad renal en pacientes con diabetes mellitus (DM) es un desafío tanto para los médicos de atención primaria como para los especialistas, porque no existe método en la práctica clínica que evalúe la tasa de filtrado glomerular (TFG) en forma precisa. Para evaluar la función renal en enfermedad renal crónica (ERC) con menos de 60 ml/min/1.73m., correspondiente a los estadios 3, 4 y 5 de la clasificación actual, los métodos disponibles en los laboratorios clínicos son de limitada exactitud. En este trabajo se desarrollarán las condiciones que debería cumplir un marcador ideal, las dificultades que ofrece la evaluación de la creatinina, la medición de la TFG, así como las ventajas y limitaciones de las recomendaciones del uso de fórmulas para su determinación, y el algoritmo actual para estimar función renal. Conclusiones: actualmente, a pesar de las limitaciones, se recomienda el empleo de fórmulas para la estimación de la TFG, sobre todo en TFG menor a 60 ml/min/1.73 m.. Es un desafío, para un futuro mediato, desarrollar mejores recursos para su evaluación.

Abstract To diagnose,classify and stage diabetic kidney disease in patients with diabetes mellitus is a challenge in clinical practice for both primary care physicians and specialists because there is no method in clinical practice that evaluates accurately the glomerular filtration rate (GFR). This challenge is due to difficulties in evaluating kidney function in stages of chronic kidney disease (CKD) below 60 ml/min/1.73m. corresponding to stages 3, 4 and 5 of the classification, because the available tools in clinical laboratories are of limited accuracy. This work explores the conditions that an ideal marker should meet, the difficulties offered by the evaluation of serum creatinine, the measurement of the glomerular filtration rate (GFR) as well as the advantages and limitations of the recommendations of the use of formulas for its determination and the current algorithm to estimate renal function. Conclusions: currently, despite the limitations, the use of formulas for the diagnosis of renal function is recommended, especially in GFR below 60 ml/min/1.73 m2. It is a challenge for the near future to develop better tools for the evaluation of TGF. Key words: renal function; glomerular filtration rate; creatinine; creatinine clearance.

Effects of transfusion load and suction pressure on renal function in intraoperative salvage autotransfusion

Although some investigations have been performed to determine the effects of transfusion load and suction pressure on renal function during intraoperative salvage autotransfusion, the precise threshold is still undetermined. A total of 625 patients undergoing surgery with the Continuous AutoTransfusion System (CATSplus) were enrolled and divided into groups according to the utilized suction pressure and transfusion volume. Plasma free hemoglobin (FHB) and creatinine clearance (CCr) were assayed to indicate the renal function. Both 0.03 MPa suction (≥4-unit load) and >5 units transfusion changed the levels of FHB and CCr significantly when measured 24 h post-operation compared to pre-operation. Under 0.02 MPa suction (≥4-unit load), the alteration of FHB and CCr returned to normal after 24 h. Under 3 units transfusion, the levels of FHB and CCr at 6 and 12 h post-operation changed significantly compared to pre-operation (P<0.05 or P<0.01, respectively), and this alteration could be restored to normal at 72 h post-operation. After an exhaustive investigation, less than 4 units transfusion and less than 0.03 MPa suction pressure are recommended for intraoperative salvage autotransfusion.

Aclaramiento de la creatinina de largo plazo en pacientes con hemorragia obstétrica / Long-term creatinine clearance in patients with obstetric hemorrhage

Resumen OBJETIVO: Determinar y comparar el aclaramiento de creatinina de largo plazo con el inicial en pacientes con hemorragia obstétrica. MATERIALES Y MÉTODOS: Estudio observacional, longitudinal, retrospectivo, comparativo y analítico llevado a cabo en una serie de pacientes con hemorragia obstétrica (pérdida ≥ 1000 mL) hospitalizadas en la unidad de cuidados intensivos. El aclaramiento de la creatinina se calculó con la fórmula CKD-EPI en dos momentos: al ingreso a cuidados intensivos durante el puerperio inmediato, complicado por hemorragia (medición inicial) y de su última consulta médica registrada (medición de largo plazo). Se utilizó estadística descriptiva y la prueba t de Student con el programa SPSS versión 20. Se consideró significativo el valor de p < 0.05. RESULTADOS: Se estudiaron 49 pacientes con media de edad de 30.48 ± 6.06 años y 32.20 ± 8.24 semanas de embarazo. En 39 de 49 se practicó cesárea, 5 de 49 tuvieron parto, 4 de 49 requirieron histerotomía y solo 1 legrado instrumental. La media de sangrado estimado fue de 2744.89 ± 1474.65 mL. Para su control se requirió cirugía en 13 de 49, dos intervenciones en 21 de 49 y tres operaciones en 15 de 49. Aclaramiento de la creatinina: medición inicial 159.09 ± 46.62 y de largo plazo (22.27 ± 1.55 meses después) 112.23 ± 30.91 mL de min de 1.73 m2 de superficie corporal. La diferencia fue significativa (p = 0.002). En la medición de largo plazo se encontró enfermedad renal crónica en 1 de las 49 pacientes. CONCLUSIONES: El aclaramiento de la creatinina de largo plazo resultó menor, quizá por la regresión de los cambios gestacionales al paso del tiempo, pero sin deterioro funcional importante, salvo un caso con enfermedad renal crónica encontrado como un hallazgo no necesariamente relacionado con la hemorragia obstétrica.

Abstract OBJECTIVE: To determine and compare long-term creatinine clearance with baseline creatinine clearance in patients with obstetric hemorrhage. MATERIALS AND METHODS: Observational, longitudinal, retrospective, comparative and analytical study carried out in a series of patients with obstetric hemorrhage (loss ≥ 1000 mL) hospitalized in the intensive care unit. Creatinine clearance was calculated with the CKD-EPI formula at two time points: on admission to intensive care after the end of pregnancy complicated by hemorrhage (baseline measurement) and from their last recorded medical consultation (long-term measurement). Descriptive statistics and Student's t-test were used with SPSS version 20, p < 0.05 was considered significant. RESULTS: Forty-nine patients with mean age of 30.48 ± 6.06 years and 32.20 ± 8.24 weeks of pregnancy were studied. Cesarean section was performed in 39 of 49, 5 of 49 delivered, 4 of 49 required hysterotomy and only one required instrumental curettage. The mean estimated bleeding was 2744.89 ± 1474.65 mL. Creatinine clearance: initial measurement 159.09 ± 46.62 and long-term (22.27 ± 1.55 months later) 112.23 ± 30.91 mL of min of 1.73 m2 body surface area. The difference was significant (p = 0.002). On long-term measurement, chronic kidney disease was found in 1 of the 49 patients. CONCLUSIONS: Long-term creatinine clearance resulted lower, perhaps due to regression of gestational changes over time, but without significant functional impairment, except for one case with chronic kidney disease found as a finding not necessarily related to obstetric hemorrhage.

A retrospective cohort study to screen linezolid-induced thrombocytopenia in adult patients hospitalized in the Midwestern Region of Brazil

ABSTRACT Background: Thrombocytopenia (TP) is the major event associated with linezolid (LZD) therapy. We investigated the incidence and risk factors for thrombocytopenia in hospitalized adults who received LZD (1200 mg/day) between 2015 and 2017. HIV-positive, death during follow-up and those with a baseline platelet count ≤100 × 103/mm3 were excluded. Method: TP was defined as a decrease in platelet count of ≥20% from the baseline level at the initiation of linezolid therapy and a final count of <100 × 103/mm3. The odds ratios (OR) for thrombocytopenia were obtained using multivariate stepwise logistic regression analysis. Main results: A total of 66 patients were included (mean age [SD] 62 [18], male gender [%], 37 [56]). LZD-associated TP was identified in 12 patients (18.2%). For TP, the adjusted OR [95% CI] of the platelet count ≤200 × 103/mm3, serum creatinine and renal impairment at baseline were 5.66 [1.15-27.9], 4.57 [1.26-16.5] and 9.41 [1.09-80.54], respectively. Male gender and dosage per weight per day (DPWD) >20 mg/kg/day were not risk factors. Conclusion: The results showed that the incidence of linezolid-induced thrombocytopenia was lower in patients with normal renal function and higher in those with platelet counts ≤200 × 103/mm3 or serum creatinine >1.5 mg/dL at the start of the treatment.

Awareness and Application of Creatinine Clearance/eGFR in Non-Nephrology Doctors

Introduction: We conducted this study to determine the awareness of usage of estimated GFR/creatinine clearance formulas while dealing with patients in various wards and outpatient departments of different tertiary hospitals in Lahore in doctors who are not working or trained in nephrology, it was done by using a questionnaire in between January 2019 to May 2019. It was found that good percentage of doctor is not using basic formulas and need education by fellow nephrology colleagues for basic patient management, drug dosing, and referral. Objective: To study the awareness and usage of creatinine clearance calculations in doctors not trained in nephrology. Study design: Descriptive, cross-sectional study. Methodology: The cross-sectional observational study was conducted. A questionnaire was designed which included questions about knowledge of estimated GFR/creatinine clearance, calculation methods, use of these formulas while dealing with patients for defining and diagnosing AKI and CKD, medicine dosage adjustment according to creatinine clearance and referral to nephrologists. Results: A total of 170 doctors working in different specialties were contacted and all of them filled questionnaire. 56 (32.9%) doctors answered that they know and calculate eGFR in routine practice while 114 (67.1%) were not performing eGFR while encountering patients. 80 (47.1%) were confident in staging chronic kidney disease and 90 (52.9%) were unable to stage chronic kidney disease on basis of eGFR. In routine patients dose and adjustment according to GFR was documented by 39 (22.9%) doctors and 131 (77.1%) doctors were not practicing dose adjustments for different medicines after calculating GFR. Referral to nephrologist was being done 99 (58.2%) doctors and 71 (41.8%) were not referring patients to nephrologists. Conclusion: Several considerable challenges remain regarding CKD and AKI early diagnosis and management and referral in Pakistan including inadequate knowledge and training systems, and needs education in this regard.

Comparación de las Fórmulas Cockcroft-Gault y Mdrd con la Depuración de la Creatinina Endógena para la Estimación de la Función Renal en Pacientes Adultos Ambulatorios Atendidos en un Hospital de Referencia Peruano / Comparison of the Cockcroft-Gault and Mdrd Equations With the Endogenous Creatinine Clearance to Estimate Renal Function in Ambulatory Adult Patients Treated in a Peruvian Reference Hospital

Resumen Introducción: La estimación de la función renal es un componente importante de laatención hospitalaria. Para ello, habitualmente, se utilizan estimaciones basadas en las cifras de creatinina sérica. Las fórmulas más utilizadas son la MDRD y Cockcroft-Gault.Objetivo:Evaluar la correlación de las ecuaciones de Cockcroft-Gault y MDRD con el valor de depuración de creatinina, basada en la recolección de orina de 24 horas. Material y métodos:Para realizar el estudio se utilizaron los registros del Servicio de Patología Clínica del HospitalNacional Hipólito Unanue, un hospital de referencia en Lima, Perú. La creatinina sérica se realizó mediante el método de Jaffe. La depuración de creatinina se llevó a cabo mediante las determinaciones simultáneas de creatinina sérica y creatinina urinaria, obtenida a través de la recolección de orina de 24 horas. Se calcularon las correlaciones utilizando el coeficiente de Pearson, considerando significativos valores de p<0.05. Resultados:Se incluyeron 426 pacientes. La edad promedio de la población estudiada fue de 58.36 +/- 16.21 años, con un mínimo de 15 años y un máximo de 91 años. Hubo un discreto predominio del género femenino (51.2%).La correlación entre la depuración de creatinina y aquella estimada por la ecuación MDRD fue de 0.57 (p<0.001); al restringir el análisis a aquellos pacientes con valores de depuración menores a 60 ml/min, la correlación fue de 0.55 (p<0.001). La correlación entre la depuración de creatinina y la estimada por la ecuación de Cockcroft-Gault fue de 0.53 (p<0.001); al restringir el análisis a pacientes con valores de depuración menores a 60 ml/min, la correlación fue de 0.55 (p<0.001). La correlación entre las fórmulas de Cockcroft-Gault y MDRD fue de 0.84 (p<0.01). En pacientes con depuraciones por debajo de 60, fue de 0.87 (p<0.01). Los resultados no mostraron diferencias al restringir las observaciones a pacientes menores de 70 años.Conclusión:Aunque las ecuaciones de Cockcroft-Gault y MDRD guardan una buena correlación entre ellas, se correlacionan de manera subóptima con la depuración de creatinina realizada mediante la recolección de 24 horas, bajo condiciones clínicas habituales.

Abstract Introduction: The estimation of renal function is an important component of hospital care. To do this, estimates are usually used, based on serum creatinine levels. The most widely used equations are MDRD and Cockcroft-Gault. Objective: To evaluate the correlation of the Cockcroft-Gault and MDRD equations with the creatinine clearance value, based on 24-hour urine collection. Methods: In order to carry out this study, the records of the Clinical Pathology Service of Hospital Nacional HipólitoUnanue, a reference hospital in Lima (Peru), were used. Serum creatinine was measured using the Jaffe's method. Creatinine clearance was performed by simultaneous determinations of serum creatinine and urinary creatinine, obtained through 24-hour urine collection. Correlations were calculated using Pearson coefficient, considering significant values ​​of p<0.05. Results: 426 patients were included. The average age was 58.36 +/- 16.21 years, with a minimum age of 15 and a maximum of 91. There was a slight female predominance (51.2%). The correlation between creatinine clearance and that estimated by the MDRD equation was 0.57 (p<0.001); when restricting the analysis to those patients with clearance values ​​lower than 60 ml/min, the correlation was 0.55 (p <0.001). The correlation between creatinine clearance and that estimated by the Cockcroft-Gault equation was 0.53 (p<0.001); when the analysis was limited to patients with purification values ​​lower than 60 ml/min, the correlation was 0.55 (p <0.001). The correlation between Cockcroft-Gault and MDRD equations was 0.84 (p<0.01). In patients with purifications below 60, it was 0.87 (p<0.01). The results showed no differences when restricting observations to patients under 70. Conclusion: Although Cockcroft-Gault and MDRD equations keep a good correlation between them, this correlation is suboptimal with creatinine clearance performed through 24-hour collection, under usual clinical conditions.

Performance of the equations to estimate the glomerular filtration rate in Mexican patients receiving kidney transplantation / Desempeño de las ecuaciones para estimar la tasa de filtración glomerular en pacientes mexicanos receptores de trasplante renal

Abstract Introduction: The management of kidney transplant recipients requires glomerular filtration rate (GFR) monitoring, which is an indicator of graft primary function and patient survival. Objective: To evaluate the performance of different creatinine or cystatin-based formulas in the estimation of glomerular filtration rate in Mexican patients receiving kidney transplantation. Method: 30 transplant recipients were included, in whom the glomerular filtration rate was measured by means of iothalamate, and was also calculated using seven equations based on cystatin or creatinine. Results: The formula with the best performance was the one proposed by the chronic kidney disease epidemiology collaboration (CKD-EPI), with a bias of −2.4 mL/min/1.73 m2: and an accuracy of 9.6; 96.7 % of patients were within 30 % of the measured GFR. The second best formula was the modification of diet in renal disease (MDRD) equation. Cystatin-based equations showed a poor performance. Conclusions: Our study suggests that, in Mexican patients receiving kidney transplantations, the best equations to estimate GFR are the CKD-EPI and MDRD equations.

Effect of Intraoperative Nephrotoxic Drugs on Renal Function in Elderly Patients Undergoing Abdominal Surgery / 中国药学杂志

OBJECTIVE: To analyze the relationship between renal function impairment and intraoperative nephrotoxic drugs in elderly patients undergoing abdominal surgery. METHODS: A retrospective analysis was performed on renal function data before and after surgery for elderly patients (≥75 years old) who underwent abdominal surgery from January 2016 to December 2017 in Xuanwu Hospital of Capital Medical University. The medication group were divided into five groups according to the type of nephrotoxic drugs used in the operation: group (H)--hetastarch (HES), group (N)-- non-steroidal anti-inflammatory drugs (NSAIDs), group (N+H)--combined use NSAIDs and HES, group (F+H)--combined use furosemide and HES, group (Z)- iodinated contrast agent. The control group did not use nephrotoxic drugs.According to the principle of pairing, patients in the untreated group and the medication group were paired, and paired t-test was used to analyze the relationship between intraoperative nephrotoxic drugs and creatinine clearance(Ccr) reduction rates after surgery. RESULTS: A total of 275 elderly patients were enrolled in the study and pairing the untreated group with the patient in the medication group, the pairing success: the number of the group (Z) is 3,and the pairing is not performed, the group (H) number is 41, the group (N) number is 15, the group (N+ H) is 21, the group (F+H) is 7. The paired t-test was used to compare the reduction rate of creatinine clearance between the two groups. The RESULTS showed that there was no significant difference in the group (H), and the other three groups′ RESULTS were all significant differences. CONCLUSION: The nephrotoxic drugs such as NSAIDs, iodinated contrast agents should be controlled during the operation. In particular, the combination of multiple nephrotoxic drugs should be avoided, such as NSAIDs combined with HES and furosemide combined with HES.

Assessment Of Renal Dysfunction In Chronic Liver Diseases

Objectives:Renal impairment in Patients with chronic liver disease is a common phenomenon and is a functional impairment. It seems difficult for the assessment of renal function abnormalities by normal parameters. We aimed to determine the usefulness of creatinine clearance by timed urine collection and Cockcroft Gault formula and Serum creatinine as parameters in assessing renal function in this cohort of patients and also to find if etiology of chronic liver disease has a bearing on renal dysfunction. Material and methods:Renal parameters of 200 patients with chronic liver disease were studied to assess the reliability of the each parameter. Results: In the present study, Only 22% of alcoholics have clearance more than 60ml/min. 58% patients were found to have creatinine clearance more than 60ml/min by Cockcroft Gault formula while only 36% Patients have that by timed urine collection where the difference was found to be statistically significant (Pvalue<0.01). Cockcroft Gault formula overestimates probably due to disparity in weight due to fluid retention. Conclusion:ThemostreliableParameterin our clinicalsetup isCreatinine clearance by timed urine collection.Presence ofAscites,lowserumalbumin levels andAlcoholic etiologyhadmorepredispositiontorenalimpairment,however, a largerstudywithmorenumber ofpatients canthrowmore ligh

Clinical study of vancomycin for appropriate dosing in severe infective patients with augmented renal clearance / 中华危重病急救医学

Objective@#To explore the impact of augmented renal clearance (ARC) on vancomycin pharmacokinetic target attainment in severe infective patients, and to analyze the initial dose of vancomycin based on the measured 12-hour urinary creatinine clearance (12 h-CLCR).@*Methods@#A retrospective observational study was conducted. The patients with severe infection, who receiving vancomycin empiric or targeted therapy, admitted to intensive care unit (ICU) of the Affiliated Drum Tower Hospital of Nanjing University Medical School from February 2013 to December 2017 were enrolled. All patients were treated with vancomycin intravenously by intermittent bolus every 6-12 hours. After four or five doses, blood samples were drawn before the next dosage for serum trough vancomycin concentration (Cmin), and target concentration was defined between 15 mg/L and 20 mg/L. The urine creatinine (UCr) was measured, and CLCR was calculated. ARC was defined as 12 h-CLCR > 130 mL·min-1·1.73 m-2. According to 12 h-CLCR before treatment, the patients were divided into ARC group and non-ARC group. The basic renal function of the patients was monitored, and the dosage of vancomycin and the dosage of vancomycin when the blood concentration reached the target were recorded. The correlations between 12 h-CLCR and the dosage of vancomycin when the blood concentration reached the target as well as the blood concentration of vancomycin were analyzed by Spearman correlation analysis. Dosage stratification analysis was carried out according to different 12 h-CLCR. The predictive value of 12 h-CLCR for vancomycin dosage when the blood concentration reached the target was evaluated by using the receiver operator characteristic curve (ROC).@*Results@#Data was provided from a total of 135 patients with severe infection, in which 102 patients met the inclusion criteria. The patients with vancomycin treatment duration less than 72 hours, chronic kidney disease Ⅴ phase, vancomycin treatment before entering ICU and those with incomplete data were excluded. The mean 12 h-CLCR was (114.31±73.38) mL·min-1·1.73 m-2. The 12 h-CLCR in ARC group (n = 44, 43.14%) was significantly higher than that in non-ARC group (n = 58, 56.86%) (mL·min-1·1.73 m-2: 179.37±59.04 vs. 65.95±35.71, P < 0.01). Target Cmin of vancomycin was achieved in 50.98% of patients (52/102), the target rate in ARC group was significantly lower than that in non-ARC group [29.55% (13/44) vs. 67.24% (39/58), P < 0.01], and the Cmin of vancomycin in ARC group was significantly lower than that in non-ARC group (mg/L: 10.98±6.09 vs. 14.67±6.20, P < 0.01). Spearman correlation analysis showed that there was a significantly negative correlation between 12 h-CLCR and initial Cmin of vancomycin (n = 102, r = -0.436, P < 0.001), but a positive correlation was found between 12 h-CLCR and vancomycin dosage when the blood concentration reached the target (n = 52, r = 0.275, P = 0.048). The patients with ARC need higher dosage for blood concentration reaching the target than those without ARC (mg·kg-1·d-1: 42.47±13.17 vs. 31.53±14.43, P < 0.01). According to 12 h-CLCR, the patients with initial treatment reaching the target were divided into five subgroups, < 40, 40-70, 71-100, 101-130 and > 130 mL·min-1·1.73 m-2. The results showed that as 12 h-CLCR increased, the attained dosage of vancomycin was also increased correspondingly. ROC curve analysis showed that when 12 h-CLCR≥69.83 mL·min-1·1.73 m-2, the attained dose of vancomycin when the blood concentration reached the target was greater than conventional dosage of 30 mg·kg-1·d-1.@*Conclusions@#Patients with ARC have low concentrations of vancomycin and often fail to achieve therapeutic target. The initial dose of vancomycin can be selected according to 12 h-CLCR, the higher the 12 h-CLCR, the more the dosage of vancomycin is. When 12 h-CLCR is greater than or equal to 69.83 mL·min-1·1.73 m-2, the dosage of vancomycin should be higher than the conventional dosage.

Potential effect of Silybum marianum L. and Cistus ladaniferus L. extracts on urine volume, creatinine clearance and renal function

Objective: To investigate the diuretic and renal effects of Silybum marianum L. and Cistus ladaniferus L. in normal rats. Methods: Four groups of rats were used in each experiment. The first group received water, the second group received Cistus ladaniferus L. extract (100 mg/kg b.wt), the third group received Silybum marianum L. extract (100 mg/kg b.wt), and the fourth group received furosemide (10 mg/kg b.wt). Variables including urine volume, plasma and urine sodium, potassium and creatinine, and creatinine clearance were measured. Two experiments were conducted. A single dose of each intervention was used and the variables were measured during 24 h, and the interventions were given daily for a total of 8 d and the variables were measured during various intervals. Results: The single dose of each plant extract increased urine volume at all-time intervals and increased urine sodium and potassium excretion without affecting plasma sodium and potassium (P<0.05). On the day 8 after daily administration, the plant extracts induced a significant diuresis and natriuresis without affecting serum electrolytes (P<0.05), while furosemide caused hypokalemia. Both plant extracts significantly increased creatinine clearance (P<0.05). Conclusions: Silybum marianum L. and Cistus ladaniferus L. increase creatinine clearance and have a significant diuretic effect without affecting serum electrolytes. Silybum marianum L. is more potent than furosemide or Cistus ladaniferus L. http://www.apjtm.org/article.asp?issn=1995-7645;year=2018;volume=11;issue=6;spage=393;epage=398;aulast=El;type=2.

Potential effect of Silybum marianum L. and Cistus ladaniferus L. extracts on urine volume, creatinine clearance and renal function

Objective:To investigate the diuretic and renal effects of Silybum marianum L. and Cistus ladaniferus L. in normal rats.Methods:Four groups of rats were used in each experiment. The first group received water, the second group received Cistus ladaniferus L. extract (100 mg/kg b.wt), the third group received Silybum marianum L. extract (100 mg/kg b.wt), and the fourth group received furosemide (10 mg/kg b.wt). Variables including urine volume, plasma and urine sodium, potassium and creatinine, and creatinine clearance were measured. Two experiments were conducted. A single dose of each intervention was used and the variables were measured during 24 h, and the interventions were given daily for a total of 8 d and the variables were measured during various intervals.Results:The single dose of each plant extract increased urine volume at all-time intervals and increased urine sodium and potassium excretion without affecting plasma sodium and potassium (P<0.05). On the day 8 after daily administration, the plant extracts induced a significant diuresis and natriuresis without affecting serum electrolytes (P<0.05), while furosemide caused hypokalemia. Both plant extracts significantly increased creatinine clearance (P<0.05).Conclusions:Silybum marianum L. and Cistus ladaniferus L. increase creatinine clearance and have a significant diuretic effect without affecting serum electrolytes. Silybum marianum L. is more potent than furosemide or Cistus ladaniferus L.

Teicoplanin trough concentrations following different loading doses in critically ill patients / 中国感染控制杂志

Objective To understand serum trough concentrations (Cmin) of teicoplanin and target concentration achieved in severely infected patients after three days treatment with different loading doses of teicoplanin,and find out optimal loading dose.Methods Severely infected patients who admitted to the intensive care unit(ICU) of a hospital from February 1,2016 to February 28,2017 were enrolled in the study.According to different drug loading doses (teicoplanin standard dose:6mg/kg;high dose:10mg/kg) and different creatinine clearance rates (Ccr:50mL/min as standard value),patients were divided into four subgroups:group of standard dose and normal Ccr (GsD1),group of standard dose and low Ccr (GSD2),group of high dose and normal Ccr (GHD1),group of high dose and low Ccr(GHD2).Serum Cmin,percentage of achieving target concentration,and adverse reactions of teicoplanin in different groups were compared.Results A total of 49 patients were enrolled in the study,17 patients were in GSD group,Cmin on 4th day before administration was (5.98 ± 2.67)mg/L;32 patients were in GHD group,Cmin on 4th day before administration was (9.05 ± 4.25)mg/L;Cmin in GHD group was higher than that in GsD group,and there was statistical difference between two groups(t=3.10,P=0.003).Values of Cmin in GSD1,GSD2,GHD1,and GHD2 groups were (5.78±2.72),(6.34±2.78),(8.21 ±3.77),and (12.07±4.81) mg/L respectively,differences among four groups were statistically significant(F =4.766,P =0.006).The Cmin in GHD2 group was higher than those in GHD1,GSD2,and GsD1 groups,percentage of achieving the target concentration were 9.09％ (1/11),16.67％ (1/6),28.00％(7/25),and 71.43％ (5/7) respectively,differences were statistically significant(x2=8.766,P=0.033).Complications associated with teicoplanin such as rash,damage to hepatic and renal function were not observed in all patients during the treatment course.Conclusion Whether the Ccr is normal or not,target Cmin can not be achieved early in patients given teicoplanin with standard loading dose;in patients with low Ccr,given high loading dose,target Cmin can be achieved early;while in patients with normal Ccr,higher loading dose may be needed.

Relationship between hyperhomocysteinemia and chronic kidney disease in children / 中华实用儿科临床杂志

Objective To investigate the detection rate and possible factors of hyperhomocysteinemia(HHcy) in children with chronic kidney disease(CKD).Methods The clinical data of children with CKD between July 2012 and September 2016 in the Department of Pediatrics,Peking University First Hospital were retrospectively collected.The homocysteine(Hcy) level of patients were measured.The other data included the general information,diagnosis and laboratory test results.Results Seventy-six pediatric patients with CKD were enrolled including 49 boys and 27 girls.The average age of the patients was (9.9±3.4) years old.The main cause of the patients in the study was primary glomerulopathy(48.7%,37/76 cases),and the rest were congenital and inherited glomerular diseases(36.8%,28/76 cases),secondary glomerular diseases(9.2%,7/76 cases)and renal tubular diseases(5.3%,4/76 cases).Fifty patients (65.8%,50/76 cases) had normal level of Hcy which was 10.40(7.30,11.62) μmol/L.Twenty-six patients(34.2%,26/76) were detected with HHcy whose Hcy level was 17.93(16.76,24.11) μmol/L.The detection rate of HHcy in CKD stage 1,stage 2,stage 3,stage 4 and stage 5 was 13.9%(5/36 cases),22.2%(2/9 cases),50.0%(4/8 cases),57.1%(4/7 cases) and 68.8%(11/16 cases) respectively,and the detection rate increased with CKD stages and the difference was statistically significant (χ2=17.574,P<0.001).The level of Hcy was 10.05(7.04,12.47) μmol/L,11.75(10.78,16.44) μmol/L,13.73(10.09,18.23) μmol/L,15.81(11.12,20.71) μmol/L and 17.39(11.86,24.76) μmol/L in CKD stage 1,stage 2,stage 3,stage 4 and stage 5,respectively.The Kruskal-Wallis test revealed that the distribution of homocysteine in CKD stages had statistically significant difference(P=0.001).Multiple linear regression model showed that creatinine clearance was an independent predicator of HHcy.Conclusions In this study of the CKD patients,the detection rate of HHcy was high and increased with the progression of CKD.HHcy is mainly influenced by creatinine clearance in CKD.The level of Hcy should be monitored regularly in children with CKD and HHcy should be treated with proper measures.

Relationship between serum homocysteine levels and contrast induced nephropathy after coronary angiography / 中国介入心脏病学杂志

Objective To explore the relationship between serum homocysteine (Hcy) level before coronary angiography(CAG) and contrast induced nephropathy (CIN) after CAG.Methods We included 2264 cases of suspected coronary heart disease from May 2013 to May 2016 and all patients received CAG examination.According to whether CIN has developed or not after CAG, the patients were divided into the non-CIN group (n=2162) and the CIN group (n=102).We analyzed and compared the clinical baseline data, serum Hcy and creatinine (Cr) levels and the estimated glomerular filtration rate between the 2 groups eGFR.Results Patients in the non-CIN group were younger and with less comorbidities of diabetes and chronic kidney disease (all P0.05).At 72 hours after CAG, Cr level of the non-CIN group (69.34±19.54 μmol/L) was lower than that of the CIN group (87.34±21.38) μmol/L (P<0.05).eGFR was higher in the non-CIN group (79.34±19.54)ml/min than that in the CIN group (67.34±21.38)ml/min (P<0.05).Linear regression analysis showed that Hcy level before CAG were positively correlated with Cr level after CAG (r=0.547,P<0.01) and negatively correlated with eGFR after CAG (r=-0.271,P<0.01).Conclusions Hcy level before CAG can be used as one of an effective parameter to predict CIN.

The peritoneal dialysis efficacy of icodextrin-based solution:a Meta-analysis / 天津医药

Objective To compare the efficacy of icodextrin-based solution (ico) and glucose-based solution (GLU) in peritoneal dialysis patients. Methods Pubmed (1996-2016.12), MEDLINE (1996-2016.12), Embase (1974-2016.12) and Cochrane library were searched by two independent investigators who conducted quality assessment and data mining and performed Meta-analysis using RevMan 5.2. Results Ten randomized controlled trials with 825 participants were included in this study, and 661 patients completed the trials at last. The Meta-analysis showed that there were no significant differences in body weight (WMD=-1.88, 95%CI:-4.68-0.93, P=0.19), fasting plasma glucose (WMD=-0.76, 95%CI:-1.79-0.28, P=0.15), plasma triglycerides (WMD=-0.56, 95%CI:-1.18-0.06, P=0.08), plasma total cholesterol (WMD=-0.17, 95%CI:-0.63-0.29, P=0.47) and adverse events (RR=1.06, 95%CI:0.86-1.29, P=0.59) between ICO group and GLU group. The peritoneal creatinine clearance (WMD=0.48, 95%CI:0.27-0.68,P<0.001) and peritoneal urea clearance (WMD=0.44, 95%CI:0.23-0.66, P<0.001) were better in ICO group than those of GLU group. Conclusion ICO can provide a better peritoneal creatinine clearance and peritoneal urea clearance, and which has the same safety compared with GLU.

The peritoneal dialysis efficacy of icodextrin-based solution:a Meta-analysis / 天津医药

Objective To compare the efficacy of icodextrin-based solution (ico) and glucose-based solution (GLU) in peritoneal dialysis patients. Methods Pubmed (1996-2016.12), MEDLINE (1996-2016.12), Embase (1974-2016.12) and Cochrane library were searched by two independent investigators who conducted quality assessment and data mining and performed Meta-analysis using RevMan 5.2. Results Ten randomized controlled trials with 825 participants were included in this study, and 661 patients completed the trials at last. The Meta-analysis showed that there were no significant differences in body weight (WMD=-1.88, 95%CI:-4.68-0.93, P=0.19), fasting plasma glucose (WMD=-0.76, 95%CI:-1.79-0.28, P=0.15), plasma triglycerides (WMD=-0.56, 95%CI:-1.18-0.06, P=0.08), plasma total cholesterol (WMD=-0.17, 95%CI:-0.63-0.29, P=0.47) and adverse events (RR=1.06, 95%CI:0.86-1.29, P=0.59) between ICO group and GLU group. The peritoneal creatinine clearance (WMD=0.48, 95%CI:0.27-0.68,P<0.001) and peritoneal urea clearance (WMD=0.44, 95%CI:0.23-0.66, P<0.001) were better in ICO group than those of GLU group. Conclusion ICO can provide a better peritoneal creatinine clearance and peritoneal urea clearance, and which has the same safety compared with GLU.

Comparison of different equations for estimated glomerular filtration rate in patients with chronic kidney disease / 中华肾脏病杂志

Objective To compare different equations for estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease (CKD).Methods Hospitalized patients with CKD from the nephrology department of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) were recruited between December 2014 and May 2015.The calculations of eGFR and 24 h creatinine clearance rate (Ccr) were accomplished in three days after admission.The eGFRs were calculated separately using the 24 h creatinine clearance rate adjusted by the standard body surface area (Ccr_BSA),Cockcroft-Gault equation adjusted by the standard body surface area (eCcr_BSA),CKD-EPI creatinine equation (EPI_Cr),CKD-EPI cystatin C equation (EPI_CysC),CKDEPI creatinine-cystatin C equation (EPI_Cr_CysC),simplified MDRD (MDRD) and China MDRD equations.The EPI_Cr_CysC equation was used as the standard and the precision and accuracy of the other six equations were compared and analyzed.Results A total of 403 CKD participants were enrolled in the study,with 228 male patients and a mean age of (54.9± 18.4) years.The main primary diseases were chronic glomerulonephritis (43.7％) and diabetic nephropathy (13.2％).The median concentration of serum creatinine and cystatin C were 117.5 (69.7,242.4) μmol/L and 1.80 (1.13,3.31) mg/L,respectively.The median values of Ccr_BSA,eCcr_BSA,MDRD,China MDRD,EPI_Cr,EPI_CysC and EPI_Cr_CysC equations were 50.8 (21.1,96.2),51.9 (23.3,93.2),53.6 (23.0,97.4),52.2(22.4,94.1),53.2 (22.1,97.3),35.1 (15.4,67.0) and 49.1 (22.8,82.3) ml · min-1 · (1.73 m2)-1,respectively.There was well agreement among MDRD,China MDRD and EPI_Cr equations,while there were large differences between equations derived from CysC (EPI_Cr_CysC and EPI_CysC) and equations derived only from creatinine (EPI_Cr,MDRD,China MDRD,eCcr_BSA,Ccr_BSA equations).Compared with EPI_Cr_CysC equation (the reference equation),EPI_Cr equation showed the highest accuracy [percentage of other eGFR equation calculations that were ＞ 30％ of the reference equation calculations (1-P30),30.8％] while Ccr_BSA equation showed the lowest (1-P30,42.4％).EPI_CysC equation showed the highest precision [inter-quartile range (IQR) of the difference,11.7 ml·min-1 · (1.73 m2)-1] while Ccr_BSA equation showed the lowest [IQR of the difference,22.8 ml· min-1 ·(1.73 m2)-1].Conclusions The agreement among equations derived only from creatinine is better;while it exhibits some differences between equations with cystatin C and equations derived only from creatinine.The accuracy of EPI_Cr equation is second only to EPI_Cr_CysC equation and it is currently the most suitable eGFR equation for clinical popularization of renal glomerular function assessment.