AIM:To evaluate the treatment options for nephrotoxicity due to cisplatin combination chemotherapy.METHODS:We retrospectively reviewed patients who had received cisplatin combination chemotherapy for gastric cancer be...AIM:To evaluate the treatment options for nephrotoxicity due to cisplatin combination chemotherapy.METHODS:We retrospectively reviewed patients who had received cisplatin combination chemotherapy for gastric cancer between January 2002 and December 2008.We investigated patients who had shown acute renal failure(ARF),and examined their clinical characteristics,laboratory data,use of preventive measures,treatment cycles,the amount of cisplatin administered,recovery period,subsequent treatments,and renal status between the recovered and unrecovered groups.RESULTS:Forty-one of the 552 patients had serum creatinine(SCR)levels greater than 1.5 mg/dL.We found that pre-ARF SCR,ARF SCR,and ARF glomerular filtration rates were significantly associated with renal status postARF between the two groups(P=0.008,0.026,0.026,respectively).On the receiver operating characteristic curve of these values,a 1.75 mg/dL ARF SCR value had 87.5%sensitivity and 84.8%specificity(P=0.011).CONCLUSION:Cessation or reduction of chemotherapy should be considered for patients who have an elevation of SCR levels during cisplatin combination chemotherapy.展开更多
A 55-year-old male patient with hepatitis B-related liver cirrhosis was found to have advanced hepatocellular carcinoma.His AFP was initially 9828μg/L and rapidly dropped to 5597μg/L in ten days after oral sorafenib...A 55-year-old male patient with hepatitis B-related liver cirrhosis was found to have advanced hepatocellular carcinoma.His AFP was initially 9828μg/L and rapidly dropped to 5597μg/L in ten days after oral sorafenib treatment.However,he developed acute renal failure, hyperkalemia,and hyperuricemia 30 d after receiving the sorafenib treatment.Tumor lysis syndrome was suspected and intensive hemodialysis was performed. Despite intensive hemodialysis and other supportive therapy,he developed multiple organ failure(liver, renal,and respiratory failure)and metabolic acidosis. The patient expired 13 d after admission.展开更多
Patients with cancer have a high inherent risk of infectious complications.In addition,the incidence of acute and chronic kidney dysfunction rises in this population.Antiinfective drugs often require dosing modificati...Patients with cancer have a high inherent risk of infectious complications.In addition,the incidence of acute and chronic kidney dysfunction rises in this population.Antiinfective drugs often require dosing modifications based on an estimate of kidney function,usually the glomerular filtration rate(GFR).However,there is still no preferential GFR formula to be used,and in acute kidney injury there is always a considerable time delay between true kidney function and estimated GFR.In most cases,the anti-infective therapy should start with an immediate and high loading dose.Pharmacokinetic as well as pharmacodynamic principles must be applied for further dose adjustment.Anti-infective drugs with time-dependent action should be given with the target of high trough concentrations(e.g.,beta lactam antibiotics,penems,vancomycin,antiviral drugs).Anti-infective drugs with concentration-dependent action should be given with the target of high peak concentrations(e.g.,aminoglycosides,daptomycin,colistin,quinolones).Our group created a pharmacokinetic database,called NEPharm,hat serves as a reference to obtain reliable dosing regimens of anti-infective drugs in kidney dysfunction as well as renal replacement therapy.To avoid the risk of either too low or too infrequent peak concentrations,we prefer the eliminated fraction rule for dose adjustment calculations.展开更多
Objective:Chemotherapy drugs such as platinum may cause damage to the renal function,creatinine clearance(Ccr),as a "golden standard" indicator in clinical evaluation of renal function,was limited in applica...Objective:Chemotherapy drugs such as platinum may cause damage to the renal function,creatinine clearance(Ccr),as a "golden standard" indicator in clinical evaluation of renal function,was limited in application due to complicated detection steps.By detecting the expression of serum Cystatin C(Cys C),Ccr and urinary micro-albumin(UMA),this study was designed to analyze and discuss their roles and status in renal function evaluation for cancer patients before and after chemotherapy with platinum.Methods:We retrospectively reviewed 110 patients who receiving platinum-containing protocols or non-platinum-containing ones,and got the expression of Cys C,Ccr(was calculated by Cockcroft-Gault equation) and UMA,then analyzed whether there were differences for Cys C,Ccr and UMA in those patients;for patients with mildly impaired renal function(Ccr between 50-75 mL/min),whether there were differences for Cys C and UMA before and after chemotherapy with platinum.Results:There was statistical significance for Ccr,Cys C and UMA in patients who receiving platinum-containing protocols(85.01 ± 28.40) vs(76.79 ± 26.63) mL/min,(1.49 ± 0.50) vs(1.80 ± 0.84) mg/L and(14.30 ± 9.15) vs(16.90 ± 10.95) mg/L,P = 0.00,0.00 and 0.01),and no statistical significance for those receiving non-platinum-containing ones(89.45 ± 29.69) vs(86.78 ± 27.96) mL/min,(1.51 ± 0.78) vs(1.63 ± 0.73)mg/L and(17.31 ± 10.46) vs(16.59 ± 8.33) mg/L,P = 0.45,0.07 and 0.57);and there were also significant differences for Cys C for patients with mildly impaired renal function before and after chemotherapy(1.68 ± 0.55) vs(2.04 ± 0.68) mg/L,P = 0.03),while no statistical significance for UMA for the same ones(21.11 ± 10.06) vs(21.22 ± 8.81) mg/L,P = 0.93).There were statistical significance both for Cys C and UMA before and after chemotherapy in platinum-containing group,but the AUC for Ccr and Cys C is greater than that for UMA(P < 0.02).Conclusion:Cys C and UMA can both access renal dysfunction early after chemotherapy,but Cys C is more sensitive than UMA in reflecting early renal dysfunction,so Cys C can replace Ccr and become a reliable indicator in the assessment of renal function for cancer patients before and after chemotherapy especially with platinum.展开更多
Objective:The aim of this study was to investigate renal insufficiency in patients with chemotherapy.Methods:Prescribing chemotherapy in a regular hemodialysis patient with renal failure,and monitoring of serum drug c...Objective:The aim of this study was to investigate renal insufficiency in patients with chemotherapy.Methods:Prescribing chemotherapy in a regular hemodialysis patient with renal failure,and monitoring of serum drug concentrations to determine its safety and effectiveness.Results:Chemotherapy assessment efficiency:SD(better),hemodialysis did not affect THP treatment,their safety was guaranteed.Conclusion:The chemotherapy of renal dysfunction is not an absolute contraindication to fully assess the patient's adverse effects and tolerability,the reasonable arrangements for hemodialysis and the timing of administration can be safe and effective chemotherapy.展开更多
文摘AIM:To evaluate the treatment options for nephrotoxicity due to cisplatin combination chemotherapy.METHODS:We retrospectively reviewed patients who had received cisplatin combination chemotherapy for gastric cancer between January 2002 and December 2008.We investigated patients who had shown acute renal failure(ARF),and examined their clinical characteristics,laboratory data,use of preventive measures,treatment cycles,the amount of cisplatin administered,recovery period,subsequent treatments,and renal status between the recovered and unrecovered groups.RESULTS:Forty-one of the 552 patients had serum creatinine(SCR)levels greater than 1.5 mg/dL.We found that pre-ARF SCR,ARF SCR,and ARF glomerular filtration rates were significantly associated with renal status postARF between the two groups(P=0.008,0.026,0.026,respectively).On the receiver operating characteristic curve of these values,a 1.75 mg/dL ARF SCR value had 87.5%sensitivity and 84.8%specificity(P=0.011).CONCLUSION:Cessation or reduction of chemotherapy should be considered for patients who have an elevation of SCR levels during cisplatin combination chemotherapy.
文摘A 55-year-old male patient with hepatitis B-related liver cirrhosis was found to have advanced hepatocellular carcinoma.His AFP was initially 9828μg/L and rapidly dropped to 5597μg/L in ten days after oral sorafenib treatment.However,he developed acute renal failure, hyperkalemia,and hyperuricemia 30 d after receiving the sorafenib treatment.Tumor lysis syndrome was suspected and intensive hemodialysis was performed. Despite intensive hemodialysis and other supportive therapy,he developed multiple organ failure(liver, renal,and respiratory failure)and metabolic acidosis. The patient expired 13 d after admission.
文摘Patients with cancer have a high inherent risk of infectious complications.In addition,the incidence of acute and chronic kidney dysfunction rises in this population.Antiinfective drugs often require dosing modifications based on an estimate of kidney function,usually the glomerular filtration rate(GFR).However,there is still no preferential GFR formula to be used,and in acute kidney injury there is always a considerable time delay between true kidney function and estimated GFR.In most cases,the anti-infective therapy should start with an immediate and high loading dose.Pharmacokinetic as well as pharmacodynamic principles must be applied for further dose adjustment.Anti-infective drugs with time-dependent action should be given with the target of high trough concentrations(e.g.,beta lactam antibiotics,penems,vancomycin,antiviral drugs).Anti-infective drugs with concentration-dependent action should be given with the target of high peak concentrations(e.g.,aminoglycosides,daptomycin,colistin,quinolones).Our group created a pharmacokinetic database,called NEPharm,hat serves as a reference to obtain reliable dosing regimens of anti-infective drugs in kidney dysfunction as well as renal replacement therapy.To avoid the risk of either too low or too infrequent peak concentrations,we prefer the eliminated fraction rule for dose adjustment calculations.
文摘Objective:Chemotherapy drugs such as platinum may cause damage to the renal function,creatinine clearance(Ccr),as a "golden standard" indicator in clinical evaluation of renal function,was limited in application due to complicated detection steps.By detecting the expression of serum Cystatin C(Cys C),Ccr and urinary micro-albumin(UMA),this study was designed to analyze and discuss their roles and status in renal function evaluation for cancer patients before and after chemotherapy with platinum.Methods:We retrospectively reviewed 110 patients who receiving platinum-containing protocols or non-platinum-containing ones,and got the expression of Cys C,Ccr(was calculated by Cockcroft-Gault equation) and UMA,then analyzed whether there were differences for Cys C,Ccr and UMA in those patients;for patients with mildly impaired renal function(Ccr between 50-75 mL/min),whether there were differences for Cys C and UMA before and after chemotherapy with platinum.Results:There was statistical significance for Ccr,Cys C and UMA in patients who receiving platinum-containing protocols(85.01 ± 28.40) vs(76.79 ± 26.63) mL/min,(1.49 ± 0.50) vs(1.80 ± 0.84) mg/L and(14.30 ± 9.15) vs(16.90 ± 10.95) mg/L,P = 0.00,0.00 and 0.01),and no statistical significance for those receiving non-platinum-containing ones(89.45 ± 29.69) vs(86.78 ± 27.96) mL/min,(1.51 ± 0.78) vs(1.63 ± 0.73)mg/L and(17.31 ± 10.46) vs(16.59 ± 8.33) mg/L,P = 0.45,0.07 and 0.57);and there were also significant differences for Cys C for patients with mildly impaired renal function before and after chemotherapy(1.68 ± 0.55) vs(2.04 ± 0.68) mg/L,P = 0.03),while no statistical significance for UMA for the same ones(21.11 ± 10.06) vs(21.22 ± 8.81) mg/L,P = 0.93).There were statistical significance both for Cys C and UMA before and after chemotherapy in platinum-containing group,but the AUC for Ccr and Cys C is greater than that for UMA(P < 0.02).Conclusion:Cys C and UMA can both access renal dysfunction early after chemotherapy,but Cys C is more sensitive than UMA in reflecting early renal dysfunction,so Cys C can replace Ccr and become a reliable indicator in the assessment of renal function for cancer patients before and after chemotherapy especially with platinum.
文摘Objective:The aim of this study was to investigate renal insufficiency in patients with chemotherapy.Methods:Prescribing chemotherapy in a regular hemodialysis patient with renal failure,and monitoring of serum drug concentrations to determine its safety and effectiveness.Results:Chemotherapy assessment efficiency:SD(better),hemodialysis did not affect THP treatment,their safety was guaranteed.Conclusion:The chemotherapy of renal dysfunction is not an absolute contraindication to fully assess the patient's adverse effects and tolerability,the reasonable arrangements for hemodialysis and the timing of administration can be safe and effective chemotherapy.
