Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · Jan 2009
Randomized Controlled Trial Multicenter StudyLongitudinal analysis of performance of estimated glomerular filtration rate as renal function declines in chronic kidney disease.
Numerous studies have assessed the accuracy of equations estimating glomerular filtration rate (eGFR) from serum creatinine in individuals with chronic kidney disease (CKD) in cross-sectional studies. Limited literature exists, however, on the consistency of performance of these equations in longitudinal studies as renal function declines. ⋯ GFR estimates are inexpensive and show an acceptable longitudinal performance for monitoring CKD patients with GFR <50 mL/min/1.73 m(2). Inaccuracies appear more substantial above this level of GFR, and care with interpretation is required.
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Nephrol. Dial. Transplant. · Jan 2009
Pharmacokinetics of ertapenem in critically ill patients with acute renal failure undergoing extended daily dialysis.
Extended (daily) dialysis (EDD) is an increasingly popular mode of renal replacement therapy in the ICU (intensive care unit) as it combines the advantages of intermittent haemodialysis (IHD) and continuous renal replacement therapy (CRRT), i.e. excellent detoxification accompanied by cardiovascular tolerability. The aim of this study was to evaluate pharmacokinetics (PK) of ertapenem, the newest carbapenem with once-daily dosing, in critically ill patients with anuric acute renal failure (ARF) undergoing EDD. ⋯ In contrast to patients undergoing regular IHD, in which a dose reduction is required, our data suggest that in patients treated with EDD a standard dose of ertapenem (1 g/day), i.e. dose for patients without renal failure, is required to maintain adequate plasma drug levels.
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Nephrol. Dial. Transplant. · Jan 2009
Editorial Comment ReviewObstructive sleep apnoea: clinical signs, diagnosis and treatment.
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Nephrol. Dial. Transplant. · Jan 2009
Enhanced clearance of highly protein-bound drugs by albumin-supplemented dialysate during modeled continuous hemodialysis.
In 2006, there were 16 796 toxic exposures attributed to valproic acid (VPA), carbamazepine (CBZ) and phenytoin (PHT) reported to the US Toxic Exposure Surveillance System. Of these, 30% (5046) were treated in a health care facility with 12 cases resulting in death. These drugs are highly protein bound and poorly dialyzable; however, it has been suggested that albumin-supplemented dialysate may enhance dialytic clearance. We investigated whether the addition of albumin to dialysate affects dialytic clearance of VPA, CBZ and PHT. ⋯ Continuous hemodialysis with albumin-supplemented dialysate significantly enhanced VPA and CBZ, but not PHT, clearance compared to control dialysate. Continuous hemodialysis with albumin-supplemented dialysate may be a promising therapy to enhance dialytic clearance of selected highly protein-bound drugs.
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Nephrol. Dial. Transplant. · Jan 2009
The great saphenous vein for central venous access and haemodialysis.
Utilising an open surgical technique the Great Saphenous vein in the proximal thigh can be used for the insertion of central venous catheters for haemodialysis. This approach is safe and efficacious, and may be performed under local or general anaesthesia. This technique is of particular importance in patients requiring vascular access for haemodialysis in whom the upper central veins are stenosed and the femoral vessels are not amenable to percutaneous cannulation. ⋯ The great saphenous vein offers an additional site for the insertion of central venous catheters. These data demonstrate equivalence in patency between this novel technique and percutaneous femoral vein cannulation.