Performance of methods to assess kidney function in a predominantly overweight sample of patients with liver disease.

The assessment of glomerular filtration rate (GFR) in patients with liver disease is necessary to make decisions about organ allocation. Creatinine is widely used as a marker of GFR; however, it is not reliable in patients with liver disease. The aims of this study were to (1) determine if iodine 125-labeled iothalamate ((125)I-iothalamate) clearance calculated using the plasma decay method is equal to renal clearance of (125)I-iothalamate and (2) estimate kidney function using the creatinine-based Cockcroft-Gault and the Modification of Diet in Renal Disease equations, a cystatin C-based equation, the urine collection method for creatinine clearance, and plasma clearance of vancomycin (V) and compare these estimates to renal clearance of (125)I-iothalamate in adult patients with liver disease. Adults with liver disease received (125)I-iothalamate and V and had a catheter placed for urine collection. Blood and urine samples were collected over 8 h for analysis of (125)I-iothalamate, creatinine, and V to determine kidney function. Estimates were compared to renal (125)I-iothalamate clearance. Eight patients classified as Child-Pugh class B were enrolled: age was 52 ± 6 years; body mass index was 36.5 ± 19 kg/m(2); and Model for End-Stage Liver Disease score was 13 ± 3. Mean estimates of kidney function did not differ significantly from mean renal (125)I-iothalamate clearance (74 ± 38 mL/min/1.73 m(2)). Other methods overestimated kidney function at lower levels of GFR (<60 mL/min/1.73 m(2)) and underestimated kidney function at higher GFR levels. Given the variability in performance of methods to assess kidney function in this population, direct measurement of GFR may be preferable to indirect estimates based on marker compounds such as creatinine and cystatin C until more accurate methods are developed.

A comprehensive approach to faculty development.

The purpose of this report was to describe the development, implementation, and outcomes from 3 complementary programs to facilitate the development of faculty members. The Faculty Development Committee (FDC) at the University of Tennessee developed 3 new complementary programs: the Individual Faculty Development Program to encourage faculty members to assess and identify their own specific developmental needs; the Seed Research Grant Program to fund scholarly activities by faculty; and the Technology Support Program to foster financial support of technology upgrades crucial for meeting the research, education, and service needs of faculty members. Eighteen faculty members participated in the Individual Faculty Development Program during the first 2 academic years and all provided positive feedback about their experiences. The Seed Research Grant Program funded 6 projects during its inaugural year. Limited outcome data from these 2 programs are extremely favorable relative to grant submissions and publications, and enhanced educational offerings and evaluations. The Technology Support Fund was initiated in the 2005-2006 academic year. The 3 faculty development programs initiated are offered as examples whereby faculty members are given a high degree of self-determination relative to identifying programs that will effectively contribute to their growth as academicians. Other colleges of pharmacy are encouraged to consider similar initiatives to foster individual faculty development at this critical period of growth within academic pharmacy.

Long-Term Treatment with Oral Torsemide and Its Effect on Body Weight and Fluid Balance in Patients with Chronic Renal Insufficiency.

Long-term treatment with oral torsemide was studied to determine its effectiveness in maintaining steady-state fluid balance in patients with chronic renal insufficiency by using a placebo-controlled, double-blind, random-off design. Patients with stable chronic renal insufficiency were initially titrated and then stabilized on torsemide. Once stabilized on torsemide, patients were randomly assigned in a double-blind fashion to continue on their titrated dose of torsemide or to receive a placebo. Of the 82 patients enrolled in the study, 68 were randomized to torsemide (n = 34) or placebo (n = 34). Patients who received the placebo showed a significantly greater (p < 0.001) mean increase in body weight (3.55 lb) than did patients who remained on torsemide (0.46 lb). Approximately two-thirds of the weight gain observed in the placebo group occurred during the first 3 days after randomization. Patients continued to receive treatment unless they developed fluid accumulation that was considered deleterious to their clinical state as determined by the investigator. In the placebo group a greater number of patients discontinued treatment because of weight gain or fluid accumulation. The mean number of days on treatment after randomization was significantly higher (p < 0.001) for patients who received torsemide (26 days) than for patients who received the placebo (16 days). The lack of weight gain in the torsemide group was associated with a higher percentage of patients who showed no change or an improvement in peripheral edema status (79%) than in placebo patients (35%). No patient was withdrawn from the study because of hyperkalemia or hypokalemia. The adverse effects reported during the study were as anticipated for patients with chronic renal insufficiency that is often complicated by other underlying illnesses.