Cisplatin Induced Nephrotoxicity- An Assessment Based on Calculated Creatinine Clearance

2016 ◽  
Vol 17 (10) ◽  
pp. 1-8 ◽  
Author(s):  
Tabrik Fathima ◽  
G Sudheer ◽  
G Smruthi ◽  
K Rajesh ◽  
D Naidu ◽  
...  
Keyword(s):  
Creatinine Clearance ◽  
Calculated Creatinine Clearance

scholarly journals Predictors of Postoperative Acute Renal Failure after Noncardiac Surgery in Patients with Previously Normal Renal Function

2007 ◽  
Vol 107 (6) ◽  
pp. 892-902 ◽  
Author(s):  
Sachin Kheterpal ◽  
Kevin K. Tremper ◽  
Michael J. Englesbe ◽  
Michael O’Reilly ◽  
Amy M. Shanks ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Creatinine Clearance ◽  
Normal Renal Function ◽  
Noncardiac Surgery ◽  
Intraoperative Management ◽  
All Cause Mortality ◽  
Calculated Creatinine Clearance ◽  
Preoperative Predictors

Background The authors investigated the incidence and risk factors for postoperative acute renal failure after major noncardiac surgery among patients with previously normal renal function. Methods Adult patients undergoing major noncardiac surgery with a preoperative calculated creatinine clearance of 80 ml/min or greater were included in a prospective, observational study at a single tertiary care university hospital. Patients were followed for the development of acute renal failure (defined as a calculated creatinine clearance of 50 ml/min or less) within the first 7 postoperative days. Patient preoperative characteristics and intraoperative anesthetic management were evaluated for associations with acute renal failure. Thirty-day, 60-day, and 1-yr all-cause mortality was also evaluated. Results A total of 65,043 cases between 2003 and 2006 were reviewed. Of these, 15,102 patients met the inclusion criteria; 121 patients developed acute renal failure (0.8%), and 14 required renal replacement therapy (0.1%). Seven independent preoperative predictors were identified (P < 0.05): age, emergent surgery, liver disease, body mass index, high-risk surgery, peripheral vascular occlusive disease, and chronic obstructive pulmonary disease necessitating chronic bronchodilator therapy. Several intraoperative management variables were independent predictors of acute renal failure: total vasopressor dose administered, use of a vasopressor infusion, and diuretic administration. Acute renal failure was associated with increased 30-day, 60-day, and 1-yr all-cause mortality. Conclusions Several preoperative predictors previously reported to be associated with acute renal failure after cardiac surgery were also found to be associated with acute renal failure after noncardiac surgery. The use of vasopressor and diuretics is also associated with acute renal failure.

Shift of the Serum Erythropoietin-vs.-Hemoglobin Curve with Frailty Status in Community-Dwelling Older Adults. Results from the Women’s Health and Aging Studies (WHAS) I and II.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3141-3141
Author(s):  
Paulo H.M. Chaves ◽  
Linda P. Fried
Keyword(s):  
Older Adults ◽  
Health Status ◽  
Creatinine Clearance ◽  
Older Women ◽  
Population Based ◽  
Community Dwelling ◽  
Low Energy ◽  
Frailty Status ◽  
Calculated Creatinine Clearance ◽  
Serum Erythropoietin

Abstract Introduction: The criteria currently used to define normal hemoglobin concentration (Hb) in older adults do not take into consideration the heterogeneity of health status. To gain insight into the potential relevance of such a consideration, we examined whether the relationship between Hb and serum erythropoietin (EPO) - a surrogate marker for tissue hypoxemia - would be modified by frailty status in community-dwelling older women. Methods: Cross-sectional analysis of data from WHAS I and II, two complementary population-based studies investigating the epidemiology of disability progression and onset (WHAS-II, 1994–1996). Baseline WHAS I (1992–1995) and II (1994–1996) data from women 70–80 yrs with known frailty status, EPO, and Hb that was moderate-to-mildly low and normal Hb (i.e., 10–16g/dL) were pooled. The final sample size was 642, after excluding subjects with outlier EPO values. Serum EPO was measured in samples stored at −70C by enzyme immunoassay; within- and between-essays coefficients of variability were 13.3% and 11.6%, respectively, indicating acceptable reproducibility. Frailty was defined according to a previously-validated, Geriatrics-accepted classification; i.e., considered present if 3 or more of the following were present: slowness (walking speed less than bottom 20th percentile), unintentional weight loss >10%, low energy expenditure (bottom 20th percentile of calculated Kcal using the Specific Activity Scale), weakness (grip strength <20th percentile), and self-reported low energy. A generalized linear model with a log-link and gamma distribution was used to estimate mean EPO, the dependent variable, as a function of Hb (continuous) and frailty status, while controlling for age (continuous) and tertiles of Cockcroft-calculated creatinine clearance. Results: Relationships between EPO and Hb in both frail and non-frail subjects were non-linear, with lowest EPO around mid-normal Hb concentrations. However, the curve in frail subjects was shifted to the right and upwards, so that mean EPO for the same Hb was on average 1.59 (1.22 – 2.06) times greater in frail than in non-frail subjects, according to a model that controlled for age and calculated creatinine clearance. Additional analyses were conducted to determine the difference in mean EPO across different Hb concentrations and between the frail and non-frail groups. For example, we estimated that when compared to the predicted mean EPO value for a Hb of 14 g/dL in frail subjects, mean EPO values linked to Hb concentrations greater or equal to 12.3 g/dL in non-frail were statistically-significant lower (p<.043). Conversely, there was no statistically-significant difference in mean EPO linked to a Hb of 14 g/dL in frail subjects vs. mean EPO linked to Hb concentrations between 12–10 g/dL in the non-frail group (p>.100). Conclusion: The shift of the EPO vs. Hb curve by frailty status observed in this population-based study of older women suggests that, as compared to their non-frail counterparts, frail subjects might require significantly higher Hb levels to achieve similar tissue oxygenation levels, as surrogate-measured by EPO levels. These findings warrant further exploration of how best take into account health status heterogeneity issues for the development of improved anemia-related clinical decision-making in older adults.

Selecting the Best Renal Function Tests:A Meta-analysis of Diagnostic Studies

1997 ◽  
Vol 13 (2) ◽  
pp. 343-356 ◽  
Author(s):  
Dirk Campens ◽  
Frank Buntinx
Keyword(s):  
General Practice ◽  
Renal Function ◽  
Literature Review ◽  
Creatinine Clearance ◽  
Gold Standard ◽  
Meta Analysis ◽  
Kidney Function Tests ◽  
First Choice ◽  
Calculated Creatinine Clearance ◽  
Methodological Strength

AbstractA literature review compared the results of different kidney function tests using the inulin clearance or similar methods as a gold standard. The methodological strength of the available studies was weak. For the time being, the calculated creatinine clearance using formula, is a first choice, especially in general practice.

Dosing Adjustment of 10 Antimicrobials for Patients with Renal Impairment

1995 ◽  
Vol 29 (12) ◽  
pp. 1202-1207 ◽  
Author(s):  
Sandra L Preston ◽  
Laurie L Briceland ◽  
Ben M Lomaestro ◽  
Timothy S Lesar ◽  
George R Bailie ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Drug Therapy ◽  
Renal Impairment ◽  
Creatinine Clearance ◽  
Oral Therapy ◽  
Antimicrobial Agents ◽  
Dosage Adjustment ◽  
Cost Avoidance ◽  
Adjustment Program ◽  
Calculated Creatinine Clearance

Objective: To describe a program of creatinine clearance–based dosage adjustment of 10 renally eliminated antimicrobial agents and to discuss the utility of such a program in a hospital as a method of quality assurance (by ensuring that patients with renal impairment receive generally accepted dosage adjustments), based on pharmacodynamic principles. Methods: Consecutive patients prescribed any of 10 targeted renally eliminated antibiotics were included. Recommendations for dosage adjustment were made to the prescriber based on a calculated creatinine clearance. Additional adjustments in drug therapy were performed, including dosage recommendations of nontargeted drugs, simplification of antibiotic regimens, and conversion of intravenous to oral therapy. A cost analysis was performed. Results: During a 6-month study period, 160 dosage changes (7.6% of total number screened) were recommended in 137 patients receiving the targeted antimicrobial agents. Prescribers accepted 147 recommendations (91.9%). A dosage change recommendation was necessary more than 12% of the time for acyclovir, ceftazidime, and imipenem/cilastatin. A cost avoidance of $11 702.08 was realized. Ancillary drug recommendations that were offered and accepted during the program realized a cost avoidance of $6613.75. Conclusions: This dosage adjustment program using pharmacodynamic principles was successful in optimization of dosing, potential minimization of morbidity caused by excessive dosing, and demonstration of direct and potentially indirect cost avoidance. A dosing program for patients with renal impairment would be of benefit to other clinicians and institutions seeking to optimize patient care.

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