Prevention of Cardiovascular Events in Patients With Chronic Kidney Disease.

OBJECTIVE: To examine the evidence base for lifestyle and pharmacologic interventions to reduce the risk of cardiovascular events in patients with chronic kidney disease, with an emphasis on reporting available data in distinct subtypes. DATA SOURCES: A PubMed search (origin to February 2023) was conducted and references for selected studies were reviewed to identify additional articles. Search terms included chronic kidney disease, major adverse cardiovascular events, and heart failure hospitalization. STUDY SELECTION AND DATA ANALYSIS: English language studies reporting cardiovascular outcomes data in patients with chronic kidney disease were included. DATA SYNTHESIS: Much of the data on interventions to prevent cardiovascular events in patients with chronic kidney disease are derived from observational studies or subgroup analyses of trials of broader populations. Some common recommendations, such as weight loss, may be harmful in certain patients. Others may only offer benefits in subgroups, such as those with albuminuria. Newer agents, such as SGLT2 inhibitors and finerenone, have clearer evidence of cardiovascular benefit, but these may also apply only to specific subgroups. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Given the prevalence of chronic kidney disease and its attendant cardiovascular risk, it is important to understand which interventions offer the greatest benefit. CONCLUSIONS: Patients diagnosed with chronic kidney disease have markedly increased risk of cardiovascular events, including myocardial infarction, stroke, heart failure, and cardiovascular death. However, until recently, there were few cardiovascular outcome studies that targeted enrollment specifically to those patients. Certain drugs now have shown benefits to cardiovascular end points in this population.

An estimate of meperidine usage in West Virginia hospitals.

PURPOSE: Meperidine (Demerol) is a synthetic opiate that has been utilized for decades. Nonetheless, its safety and efficacy profile relative to other opiates have led many to advocate against its use. We attempted to estimate current usage of meperidine by hospitals in West Virginia. METHODS: Pharmacists at each hospital in West Virginia were surveyed by telephone. They were asked to estimate meperidine use as a proportion of all opiates used in their hospital. They were also queried about usage patterns and for the presence of any documented restrictions on the use of meperidine. RESULTS: 64% of hospitals in West Virginia report low usage of meperidine (<10% of all opiates). Of those hospitals with meperidine available on formulary, 47% reported the presence of documented policies or practices designed to limit meperidine usage. When used, meperidine is most commonly administered in connection with surgical procedures. CONCLUSIONS: Many West Virginia hospitals are limiting meperidine usage, in apparent accordance with guideline recommendations. However, traditional patterns of usage for certain indications remain.

Methadone as an analgesic: a review of the risks and benefits.

While methadone has been available for over 50 years, its use in opiate dependence has overshadowed its use as an analgesic. Within the last 10-15 years, though, methadone has been increasingly used to manage neuoropathic pain and cancer pain, but its use is causing an alarming number of deaths in the U.S. Last June, The Charleston Gazette ran a series titled "The Killer Cure" by Scott Finn and Tara Tuckwiller that found that the number of Americans whose deaths were caused by methadone rose from 790 in 1999 to 2,992 in 2003. The series also reported other statistics from the National Center for Health Statistics that revealed that West Virginia ranked first per capita in methadone overdose deaths, and that methadone was more likely involved in overdose deaths than any other prescription drug. Methadone has several unique properties that can be beneficial in the treatment of neuropathic pain and cancer pain unresponsive to other opioids, but some of these properties make it very dangerous and difficult to prescribe properly. As a result of these factors, methadone should not be the first-choice drug for pain and it should not be used in opioid-naive patients. The goal of this article is to provide a review of the properties and protocols for safe prescribing of methadone to help physicians recognize situations where this drug offers the greatest advantage as an analgesic.