Characteristics of population with normal serum creatinine impaired renal function and: The validation of a MDRD formula in a healthy general population

Kang, Young Sun; Han, Kum-Hyun; Han, Sang-Youb; Kim, H K; R, D

doi:10.5414/cnp63258

Cited by 33 publications

(26 citation statements)

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“…The MDRD study formula (21) and the Cockcroft-Gault formula have great accuracy and precision with true GFR and can be applied to the healthy general population (19). Even if some authors found that these formulas were not optimal for recently admitted critically ill patients (17), the MDRD equation has been found superior to Cockcroft-Gault formulas in renal transplant recipients (30), for predicting aminoglycoside dosing recommendations (5), and in the general population (37).…”

Section: Discussionmentioning

confidence: 99%

Population Pharmacokinetics of Ceftazidime in Intensive Care Unit Patients: Influence of Glomerular Filtration Rate, Mechanical Ventilation, and Reason for Admission

Georges¹,

Conil²,

Seguin³

et al. 2009

Antimicrob Agents Chemother

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The aim of this study was to develop a population-pharmacokinetic model of ceftazidime in intensive care unit patients to include the influence of patients' characteristics on the pharmacokinetics. Forty-nine patients for model building and 23 patients for validation were included in a randomized study. They received ceftazidime at 2 g three times a day or as 6 g per day continuously. A NONMEM pharmacokinetic model was constructed, and the influences of covariates were studied. The model was validated by a comparison of the predicted and observed concentrations. A final model was elaborated from the whole population. Total clearance (CL) was significantly correlated with the glomerular filtration rate (GFR) calculated by modification of the diet in renal disease (MDRD), the central volume of distribution (V1) with intubation, and the peripheral volume of distribution (V2) with the reason for admission. The mean pharmacokinetic parameters were as follows: CL, 5.48 liters/h, 40%; V1, 10.48 liters, 34%; V2, 32.12 liters, 59%; total volume, 42.60 liters, 45%; and intercompartmental clearance, 16.19 liters/h, 42%. In the polytrauma population (mechanically ventilated), the time above the MIC at steady state never corresponds to 100% for discontinuous administration, and the target concentration of five times the MIC was reached with a 6-g/day dose only for patients with an MDRD of <150 ml/min. We showed that the GFR-MDRD, mechanical ventilation, and the reason for admission may influence the achieved concentrations of ceftazidime. Our model allows the a priori dosing to be adjusted to the individual patient.

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Section: Discussionmentioning

confidence: 99%

Population Pharmacokinetics of Ceftazidime in Intensive Care Unit Patients: Influence of Glomerular Filtration Rate, Mechanical Ventilation, and Reason for Admission

Georges¹,

Conil²,

Seguin³

et al. 2009

Antimicrob Agents Chemother

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“…One hundred and five consecutive patients who had a calculated glomerular filtration rate (GFR) of <90 mL/min/ 1.73 m 2 , which was calculated as described previously, 9 and normal coronary arteries on coronary angiography were enrolled in the study (group 1) and were compared with 102 age-and sex-matched individuals with normal coronary arteries and normal calculated GFR (group 2). 9 Informed consent was obtained from all participants.…”

Section: Methodsmentioning

confidence: 99%

“…9 Informed consent was obtained from all participants. All participants were referred to coronary angiography by independent authors because of symptoms or following the results of noninvasive tests.…”

Section: Methodsmentioning

confidence: 99%

Coronary Flow Slows as Renal Function Worsens

Yilmaz

Yalta

2009

Clinical Cardiology

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Background: Slow coronary flow in patients without obstructive coronary artery disease is an angiographic finding that could easily be detected by thrombolysis in myocardial infarction (TIMI) frame counts. On the other hand, impaired renal function is a frequent problem. We searched the association between the 2 entities. Hypothesis: We evaluated the impact of impaired renal function on slow coronary flow. Methods: In this study, 105 patients with normal coronary arteries and impaired renal function in the form of a calculated glomerular filtration rate (GFR) <90 mL/min/1.73 m 2 were enrolled and compared with 102 ageand sex-matched controls who had normal a GFR. Results: Calculated GFR was found to be negatively correlated with TIMI frame count in LAD (r = −0.579, p<0.001), in CX (r = −0.499, p<0.001), and in RCA (r = −0.491, p<0.001) in patients with impaired renal function. After adjusting for systolic and diastolic blood pressure and high-density lipoprotein (HDL) cholesterol, multiple regression analysis demonstrated a statistically significant and independent relationship between TIMI frame count for 3 vessels and calculated GFR. Conclusions: Impaired renal function seems to denote slower coronary flow in patients with normal coronary arteries compared with those with normal renal function, and there seems to be an independent association between GFR and TIMI frame count in those with impaired renal function. IntroductionNormal or near-normal coronary angiograms are found in approximately 15%-20% of patients undergoing coronary angiography because of clinical suspicion of angina pectoris. 1 In a subset of these patients, coronary angiography may show coronary slow flow (CSF) characterized by the slow progression of contrast dye in the absence of obstructive coronary artery disease. It has been suggested that a higher thrombolysis in myocardial infarction (TIMI) frame count, a simple clinical tool for assessing quantitative indexes of coronary blood flow, 2 may reflect vascular dysfunction. 3 Normal endothelium plays a vital role in the regulation of vascular tone through the production and release of various factors. 4 Nitric oxide, the major endogenous relaxing factor of the endothelium, is the crucial determinant of normal endothelial function. 5,6 On the other hand, the association between end-stage renal disease (ESRD) and endothelial dysfunction, which could yield a poor prognosis, is well established and could be the result of asymmetric dimethyl arginine (ADMA). 7,8 In the present study, we aimed to show whether there was any association between coronary blood flow by TIMI frame count and glomerular filtration rate in patients with impaired renal function (those with calculated glomerular filtration rate <90 mL/min/1.73 m 2 ) who had angiographically proven normal coronary arteries and to compare them with those with normal renal function and coronary arteries.

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“…Creatinine, urea levels and the estimated glomerular filtration rate using the MDRD formula (modification of diet in renal disease) 12 were recorded. A pre-operative creatinine level > 125 μmol/l was the exclusion criterion for renal dysfunction.…”

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confidence: 99%

Reduction of blood loss with the use of a new combined intra-operative and post-operative autologous blood transfusion system compared with no drainage in primary total hip replacement

Horstmann

Swierstra

Ohanis

et al. 2013

The Bone & Joint Journal

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Autologous retransfusion and no-drainage are both blood-saving measures in total hip replacement (THR). A new combined intra-and post-operative autotransfusion filter system has been developed especially for primary THR, and we conducted a randomised controlled blinded study comparing this with no-drainage.A total of 204 THR patients were randomised to autologous blood transfusion (ABT) (n = 102) or no-drainage (n = 102). In the ABT group, a mean of 488 ml (SD 252) of blood was retransfused. The mean lowest post-operative haemoglobin level during the hospital stay was higher in the autotransfusion group (10.6 g/dl (7.8 to 13.9) vs 10.2 g/dl (7.5 to 13.3); p = 0.01). The mean haemoglobin levels for the ABT and no-drainage groups were not significantly different on the first day (11.3 g/dl (7.8 to 13.9) vs 11.0 g/dl (8.1 to 13.4); p = 0.07), the second day (11.1 g/dl (8.2 to 13.8) vs 10.8 g/dl (7.5 to 13. It has been reported that total hip replacement (THR) is associated with a mean total blood loss of 1500 ml and a post-operative decline in haemoglobin (Hb) levels of a mean of 3.0 g/dl.1 Lower post-operative Hb levels following THR are associated with a lower functional score, longer hospital stay and an increased homologous blood transfusion rate. 2-4Homologous blood transfusions (HBT) are also related to poorer outcomes following THR, such as higher post-operative infection rates, delayed wound healing and prolonged hospital stay. [5][6][7][8] Retransfusion of blood that is lost during and after surgery has been introduced to reduce peri-operative net blood loss, maintain higher post-operative Hb levels and reduce the use of HBT. The results of a recent Cochrane review on peri-operative cell salvage show that autologous retransfusion reduced HBT requirements by 54% compared with regular drains in orthopaedic procedures. 9Post-operative autologous blood transfusion (ABT) filter systems for the retransfusion of filtered drained blood are often used in primary THR. However, the currently available intra-operative cell-saver devices wash the blood, separate the various cells and permit retransfusion of the red blood cells. Unfortunately, they are expensive to run and are often reserved for revision surgery. As a result, the 500 ml or so of blood that is generally lost during primary THR is not used for retransfusion. Therefore, a new system has been developed for primary THR, which filters the intraoperatively collected blood, in the same manner as the filters in post-operative ABT systems. This intra-operative retransfusion filter system is claimed to be easier to handle and less expensive than intra-operative washing/separating devices, and therefore suitable for use in

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Characteristics of population with normal serum creatinine impaired renal function and: The validation of a MDRD formula in a healthy general population

Cited by 33 publications

References 0 publications

Population Pharmacokinetics of Ceftazidime in Intensive Care Unit Patients: Influence of Glomerular Filtration Rate, Mechanical Ventilation, and Reason for Admission

Population Pharmacokinetics of Ceftazidime in Intensive Care Unit Patients: Influence of Glomerular Filtration Rate, Mechanical Ventilation, and Reason for Admission

Coronary Flow Slows as Renal Function Worsens

Reduction of blood loss with the use of a new combined intra-operative and post-operative autologous blood transfusion system compared with no drainage in primary total hip replacement

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