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Related Concept Videos

Chronic Kidney Disease I: Introduction01:25

Chronic Kidney Disease I: Introduction

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Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
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Analysis of Population Pharmacokinetic Data01:12

Analysis of Population Pharmacokinetic Data

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Analysis of population pharmacokinetic data involves studying the behavior of drugs within diverse populations to understand their pharmacokinetic parameters. Traditional pharmacokinetic methods typically involve collecting samples from a few individuals and estimating these parameters. While these methods are commonly used, they have limitations in capturing the variability in drug response among individuals or heterogeneous populations. Population pharmacokinetics is employed to address these...
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Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment01:08

Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment

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Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...
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Chronic Kidney Disease II: Clinical Manifestations01:24

Chronic Kidney Disease II: Clinical Manifestations

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Chronic Kidney Disease (CKD) progressively impairs multiple body systems due to the accumulation of uremic toxins, which disrupt cellular functions across various organs.Neurologic symptomsNeurologic symptoms often arise early in CKD, as uremic toxin buildup drives changes in cognitive and motor functions. Patients frequently experience fatigue, headache, confusion, difficulty concentrating, and, in severe cases, seizures. Peripheral neuropathy commonly manifests as burning sensations in the...
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Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow01:26

Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow

219
Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug...
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Chronic Kidney Disease III: Interprofessional Care01:28

Chronic Kidney Disease III: Interprofessional Care

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Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
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Assessment of Vascular Function in Patients With Chronic Kidney Disease
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Optimizing Vancomycin Dosing in Chronic Kidney Disease by Deriving and Implementing a Web-Based Tool Using a

Sreemanee Raaj Dorajoo1,2, Chrystal Leandra Winata1, Jessica Hui Fen Goh1,2

  • 1Department of Pharmacy, National University of Singapore, Singapore, Singapore.

Frontiers in Pharmacology
|June 28, 2019
PubMed
Summary

Precise vancomycin dosing for chronic kidney disease (CKD) patients is crucial. A new population pharmacokinetic model, VancApp, shows promise in improving drug exposure and clinical outcomes in non-dialysis CKD patients.

Keywords:
chronic renal failurepopulation pharmacokineticsprecision medicineprediction modellingvancomycin

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Area of Science:

  • Pharmacokinetics and Pharmacodynamics
  • Nephrology
  • Infectious Diseases

Background:

  • Chronic kidney disease (CKD) patients require careful vancomycin dosing to prevent adverse events.
  • Sub- and supratherapeutic vancomycin exposure poses significant risks in CKD patients.

Purpose of the Study:

  • To develop and validate a vancomycin dose prediction model for non-dialysis CKD patients.
  • To assess the clinical impact of a vancomycin dosing web application (VancApp) on patient outcomes.

Main Methods:

  • Population pharmacokinetic analysis to create a vancomycin dose prediction model.
  • External validation of the model on an independent patient cohort.
  • Implementation of the model into a web application (VancApp) for routine care and post-implementation outcome assessment.

Main Results:

  • The population pharmacokinetic model estimated clearance at 1.30 L/h and volume of distribution at 1.23 L/kg.
  • External validation showed a mean absolute prediction error of 1.25 mg/L.
  • VancApp-based dosing demonstrated a trend towards faster attainment of target vancomycin concentrations and reduced 30-day mortality compared to usual care.

Conclusions:

  • A population pharmacokinetic model for vancomycin can enhance dosing precision in CKD.
  • VancApp implementation shows potential for improving clinical outcomes in CKD patients requiring vancomycin.