Serum cystatin C level for better assessment of glomerular filtration rate in cystic fibrosis patients treated by amikacin

Halačová, Milada; Kotaška, Karel; Kukačka, Jiří; Vávrová, V.; Kuželová, M; Ticha, J.; Průša, Richard

doi:10.1111/j.1365-2710.2008.00932.x

Cited by 23 publications

(14 citation statements)

References 31 publications

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“…This was in agreement with previous findings, showing that CysC was more precise to predict GFR than the creatinine‐based Cockcroft–Gault equation in elderly patients . Only one study was conducted in children, showing that amikacin clearance was better correlated with CysC than serum creatinine . In addition, Neamatollah et al .…”

Section: Discussionsupporting

confidence: 92%

“…The underlying disease and mechanisms of renal impairment were variable in the present analysis, as the studies were conducted in healthy volunteers, cystic fibrosis and cancer patients. In patients with cystic fibrosis, amikacin clearance was better correlated with CysC than creatinine . These results are in accordance with the findings by Beringer et al who reported that the CysC formula demonstrated greater sensitivity and specificity to quantify GFR in cystic fibrosis patients compared with the equations with serum creatinine (Cockcroft–Gault; MDRD).…”

Section: Discussionsupporting

confidence: 90%

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Cystatin C as a potential biomarker for dosing of renally excreted drugs

Brou

Jacqz-Aigrain

Zhao

2015

Brit J Clinical Pharma

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The objective of the present study was to review the available pharmacokinetic evidence for the utility of cystatin C (CysC) as a marker of renal function to predict the dose of renally excreted drugs.The bibliographic search used PubMed and EMBASE databases, from its inception through to January 2014, with the following keywords 'pharmacokinetics' and 'cystatin C'.Sixteen pharmacokinetic publications were identified and seven drugs primarily excreted by the kidney were studied. Among them, only one study was performed in children, the others were performed in adults and/or elderly subjects, either healthy volunteers or patients with variable clinical conditions, such as cystic fibrosis and cancer. Most of studies (n = 13/16) demonstrated that CysC was better correlated with clearance/trough concentration of evaluated drugs compared with creatinine.Our review supports that CysC is a good marker of renal function to predict dose of renally excreted drugs. Efforts should be made to evaluate the impact of CysC in special populations in order to define its clinical value in dosing optimization.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Cystatin C as a potential biomarker for dosing of renally excreted drugs

Brou

Jacqz-Aigrain

Zhao

2015

Brit J Clinical Pharma

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“…UCr has similarly been found to be a problematic normalization factor both within certain populations (2, 4, 24) and when used to compare biomarker measurements across different demographic groups with known variability in UCr (2–4, 25). Previous studies have likewise shown decreased UCr levels from 24-hour urine samples in the stable CF population compared to age-matched control patients (25–26) as well as decreased renal function with aminoglycoside use (10–13, 27–28). This, in addition to the association with SG observed here, suggests that the lower UCr values in the hospitalized CF population are likely the result of lower creatinine production and impaired renal function rather than lower specimen concentration.…”

Section: Discussionmentioning

confidence: 72%

The applicability of urinary creatinine as a method of specimen normalization in the cystic fibrosis population

Wagner

Accurso

Laguna

2010

Journal of Cystic Fibrosis

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Background Urine specimens are commonly used in biomarker research. Urinary creatinine (UCr) is often used to adjust for urine analyte concentration. We aim to explore the applicability of UCr as a normalization method in a cystic fibrosis (CF) population during hospitalization. Methods Multiple spot urine samples were collected from CF patients hospitalized for a pulmonary exacerbation. Single spot specimens were obtained from asthmatics and healthy children for comparison. The assumptions and implications from the use of UCr as a normalization factor for urinary desmosine measurements were investigated. Results UCr differed significantly across disease groups and decreased significantly over time in the CF population. Differing results were obtained when contrasting normalization by UCr with specific gravity. Conclusions UCr levels are not completely attributable to simply variations in urine concentration. Analysis of urinary biomarker measurements should be initiated with an understanding of the relative effects of the normalization process on the results.

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“…Finally, CysC was found to better predict elimination of renally excreted drugs in adults compared to Scr or CrCL (29)(30)(31)(32). This is only the second report to identify this new biomarker as a predictor of renal drug clearance in children at the expense of Scr or CrCL (33). Treatment with vasopressors (mainly norepinephrine; 14/15 patients) was also associated with an 18% decrease in amoxicillin clearance.…”

Section: Discussionmentioning

confidence: 77%

Augmented Renal Clearance Implies a Need for Increased Amoxicillin-Clavulanic Acid Dosing in Critically Ill Children

Cock

Standing

Barker

et al. 2015

Antimicrob Agents Chemother

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There is little data available to guide amoxicillin-clavulanic acid dosing in critically ill children. The primary objective of this study was to investigate the pharmacokinetics of both compounds in this pediatric subpopulation. Patients admitted to the pediatric intensive care unit (ICU) in whom intravenous amoxicillin-clavulanic acid was indicated (25 to 35 mg/kg of body weight every 6 h) were enrolled. Population pharmacokinetic analysis was conducted, and the clinical outcome was documented. A total of 325 and 151 blood samples were collected from 50 patients (median age, 2.58 years; age range, 1 month to 15 years) treated with amoxicillin and clavulanic acid, respectively. A three-compartment model for amoxicillin and a two-compartment model for clavulanic acid best described the data, in which allometric weight scaling and maturation functions were added a priori to scale for size and age. In addition, plasma cystatin C and concomitant treatment with vasopressors were identified to have a significant influence on amoxicillin clearance. The typical population values of clearance for amoxicillin and clavulanic acid were 17.97 liters/h/70 kg and 12.20 liters/h/70 kg, respectively. In 32% of the treated patients, amoxicillin-clavulanic acid therapy was stopped prematurely due to clinical failure, and the patient was switched to broader-spectrum antibiotic treatment. Monte Carlo simulations demonstrated that four-hourly dosing of 25 mg/kg was required to achieve the therapeutic target for both amoxicillin and clavulanic acid. For patients with augmented renal function, a 1-h infusion was preferable to bolus dosing. Current published dosing regimens result in subtherapeutic concentrations in the early period of sepsis due to augmented renal clearance, which risks clinical failure in critically ill children, and therefore need to be updated. (This study has been registered at Clinicaltrials.gov as an observational study [NCT02456974].)

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Serum cystatin C level for better assessment of glomerular filtration rate in cystic fibrosis patients treated by amikacin

Cited by 23 publications

References 31 publications

Cystatin C as a potential biomarker for dosing of renally excreted drugs

Cystatin C as a potential biomarker for dosing of renally excreted drugs

The applicability of urinary creatinine as a method of specimen normalization in the cystic fibrosis population

Augmented Renal Clearance Implies a Need for Increased Amoxicillin-Clavulanic Acid Dosing in Critically Ill Children

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