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Kong W, Pan Y, Wu Y, Hu Y, Jiang Z, Tian X, Bi S, Wang S, Feng F, Jin Y, Li J, Li H, Wang Y, Liang H, Tang W, Liu D. Microdose Cocktail Study Reveals the Activity and Key Influencing Factors of OATP1B, P-Gp, BCRP, and CYP3A in End-Stage Renal Disease Patients. Clin Pharmacol Ther 2025; 117:1303-1312. [PMID: 39789999 PMCID: PMC11993298 DOI: 10.1002/cpt.3546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 12/16/2024] [Indexed: 01/12/2025]
Abstract
OATP1B, P-gp, BCRP, and CYP3A are the most contributing drug-metabolizing enzymes or transporters (DMETs) for commonly prescribed medication. Their activities may change in end-stage renal disease (ESRD) patients with large inter-individual variabilities (IIVs), leading to altered substrate drug exposure and ultimately elevated safety risk. However, the changing extent and indictive influencing factors are not quantified so far. Here, a microdose cocktail regimen containing five sensitive substrate drugs (pitavastatin, dabigatran etexilate, rosuvastatin, midazolam, and atorvastatin) for these DMETs was administrated to Chinese healthy volunteers and ESRD patients. Drug pharmacokinetics profiles were determined, together with physiological, pharmacogenetic, and gut microbiome signature. Population pharmacokinetic and machine learning model were established to identify key influencing factors and quantify their contribution to drug exposure change. The exposure of pitavastatin, dabigatran, rosuvastatin, and atorvastatin increased to 1.8-, 3.1-, 1.1-, and 1.3-fold, respectively, whereas midazolam exposure decreased by 72% in ESRD patients. Notably, in addition to disease state, the relative abundance of genus Veillonella and Clostridium_XIVb were firstly identified as significant influencing factors for PTV and RSV apparent clearance, respectively, suggesting their indicative role for OATP and BCRP activity evaluation. Moreover, several genera were found to strongly associate with drug clearance and reduce unexplained IIVs. Accordingly, it was estimated that OATP1B and intestine P-gp activity decreased by 35-75% and 29-44%, respectively, whereas BCRP and CYP3A4 activity may upregulate to some extent. Our study provides a quantitative and mechanistic understanding of individual DMET activity and could support precision medicine of substrate drugs in ESRD patients.
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Affiliation(s)
- Weijie Kong
- Department of NephrologyPeking University Third HospitalBeijingChina
- Drug Clinical Trial CenterPeking University Third HospitalBeijingChina
| | - Yuejuan Pan
- Department of NephrologyPeking University Third HospitalBeijingChina
| | - Yujie Wu
- Department of NephrologyPeking University Third HospitalBeijingChina
- Drug Clinical Trial CenterPeking University Third HospitalBeijingChina
| | - Yiyi Hu
- Department of NephrologyPeking University Third HospitalBeijingChina
- Drug Clinical Trial CenterPeking University Third HospitalBeijingChina
| | - Zhenbin Jiang
- Department of NephrologyPeking University Third HospitalBeijingChina
| | - Xinkui Tian
- Department of NephrologyPeking University Third HospitalBeijingChina
| | - Shuhong Bi
- Department of NephrologyPeking University Third HospitalBeijingChina
| | - Song Wang
- Department of NephrologyPeking University Third HospitalBeijingChina
| | - Feifei Feng
- Drug Clinical Trial CenterPeking University Third HospitalBeijingChina
| | - Yuyan Jin
- Drug Clinical Trial CenterPeking University Third HospitalBeijingChina
| | - Jiayu Li
- Department of NephrologyPeking University Third HospitalBeijingChina
- Drug Clinical Trial CenterPeking University Third HospitalBeijingChina
| | - Haiyan Li
- Drug Clinical Trial CenterPeking University Third HospitalBeijingChina
- Institute of Medical InnovationPeking University Third HospitalBeijingChina
| | - Yue Wang
- Department of NephrologyPeking University Third HospitalBeijingChina
| | - Hao Liang
- Department of NephrologyPeking University Third HospitalBeijingChina
- Drug Clinical Trial CenterPeking University Third HospitalBeijingChina
| | - Wen Tang
- Department of NephrologyPeking University Third HospitalBeijingChina
| | - Dongyang Liu
- Drug Clinical Trial CenterPeking University Third HospitalBeijingChina
- Institute of Medical InnovationPeking University Third HospitalBeijingChina
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Pogson CM, Austin R, Patel JP, Wheeler DC. Medication review interventions for adults living with advanced chronic kidney disease: A scoping review. Br J Clin Pharmacol 2025; 91:1132-1156. [PMID: 39739541 PMCID: PMC11992660 DOI: 10.1111/bcp.16363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 10/28/2024] [Accepted: 11/11/2024] [Indexed: 01/02/2025] Open
Abstract
Structured medication reviews (SMRs) were introduced into the National Health Service (NHS) Primary Care to support the delivery of the NHS Long-Term Plan for medicines optimization. SMRs improve the quality of care, reduce harm and offer value for money. However, evidence to support SMRs for patients with chronic kidney disease (CKD) stage G4-5D with elevated risk of cardiovascular disease and premature mortality is unknown. This scoping review aimed to assess the extent and nature of SMR research in the population of patients with CKD stage G4-5D. Electronic databases were searched on 20 October 2023. Studies were eligible if they described an SMR in adults with CKD stage G4-5D, regardless of the study design. Data detailing the global patterns, population and intervention descriptions, professionals performing SMR, and reported areas for future research were extracted. The extracted outcome data were categorized as clinical, patient-important, medication-related and experience-related. A narrative synthesis was completed. Seventeen studies (81%) were conducted in nephrology outpatient settings, three (14%) during acute hospital admissions and one (5%) within the community pharmacy. Eighteen studies (86%) were quantitative, including five randomized controlled trials. Ten (48%) studies were undertaken in the United States and Canada, and two in Europe (France and Norway). No such studies have been conducted in the United Kingdom. Our review revealed that there is a lack of evidence for SMR as a strategy to reduce polypharmacy and harms from medication for adults with CKD stage G4-5D. Therefore, further research is required in this area.
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Affiliation(s)
| | - Rosalynn Austin
- Department of Public Health, Faculty of Health SciencesUniversity of StavangerStavangerNorway
- Cardiology DepartmentPortsmouth Hospitals University NHS TrustPortsmouthUK
- NIHR Applied Research Collaborative WessexInnovation CentreSouthamptonUK
| | - Jignesh Prakash Patel
- Institute of Pharmaceutical Science, Faculty of Life Sciences & MedicineKings College LondonLondonUK
- Department of Haematological MedicineKing's College Hospital Foundation NHS TrustLondonUnited Kingdom
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Ghimire A, Lloyd AM, Bello AK, Battistella M, Ronksley P, Tonelli M. Prescribing patterns and medication costs in patients on maintenance haemodialysis and peritoneal dialysis. Nephrol Dial Transplant 2025; 40:360-370. [PMID: 38964833 PMCID: PMC11852291 DOI: 10.1093/ndt/gfae154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Polypharmacy is a significant clinical issue for patients on dialysis but has been incompletely studied. We investigated the prevalence and costs of polypharmacy in a population-based cohort of participants treated with haemodialysis (HD) or peritoneal dialysis (PD). METHODS We studied adults ≥20 years of age in Alberta, Canada receiving maintenance HD or PD as of 31 March 2019. We characterized participants as users of 0-29 drug categories of interest and those ≥65 years of age as users/non-users of potentially inappropriate medications (PIMs). We calculated the number of drug categories, daily pill burden, total annual cost and annual cost per participant and compared this to an age- and sex-matched cohort from the general Alberta population. RESULTS Among 2248 participants (mean age 63 years; 39% female) on HD (n = 1781) or PD (n = 467), the median number of prescribed drug categories was 6 [interquartile range (IQR) 4-8] and the median daily pill burden was 8.0 (IQR 4.6-12.6), with 5% prescribed ≥21.7 pills/day and 16.5% prescribed ≥15 pills/day. Twelve percent were prescribed at least one drug that is contraindicated in kidney failure. The median annual per-participant cost was ${\$}$3831, totalling ≈${\$}$11.6 million annually for all participants. When restricting to the 1063 participants ≥65 years of age, the median number of PIM categories was 2 (IQR 1-2), with a median PIM pill burden of 1.2 pills/day (IQR 0.5-2.4). Compared with PD participants, HD participants had a similar daily pill burden, higher use of PIMs and higher annual per-participant cost. Pill burden and associated costs for participants on dialysis were >3-fold and 10-fold higher, respectively, compared with the matched participants from the general population. CONCLUSION Participants on dialysis have markedly higher use of prescription medications and associated costs than the general population. Effective methods to de-prescribe in the dialysis population are needed.
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Affiliation(s)
- Anukul Ghimire
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Anita M Lloyd
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Paul Ronksley
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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Park CH, Ko YE, Heo GY, Kim BY, Oh SJ, Han SY, Park JT, Han SH, Yoo TH, Kang SW, Kim HW. Medication Burden and Adverse Cardiovascular Events and Death in Patients Treated with Maintenance Hemodialysis: A Nationwide Cohort Study. Clin J Am Soc Nephrol 2025; 20:72-80. [PMID: 39729594 PMCID: PMC11737448 DOI: 10.2215/cjn.0000000000000570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 09/17/2024] [Indexed: 12/29/2024]
Abstract
Key Points A higher medication burden was associated with a higher risk of adverse events in patients receiving maintenance hemodialysis. Medication burden can serve as a clinically relevant risk indicator for cardiovascular events and all-cause death in patients on maintenance hemodialysis. Background A high medication burden is associated with adverse outcomes. Although patients with ESKD have a substantial medication burden, the relationship between the number of medications in use and clinical outcomes in these patients remains unclear. Hence, this study aimed to investigate the prognostic implications of medication burden regarding adverse outcomes in patients with ESKD on maintenance hemodialysis. Methods We analyzed 29,690 patients receiving maintenance hemodialysis who participated in the Periodic Hemodialysis Quality Assessment conducted by the Health Insurance Review and Assessment Service. The exposure of interest was the number of routinely prescribed oral medications. The main outcome was a composite of nonfatal cardiovascular events (nonfatal myocardial infarction, coronary revascularization, nonfatal stroke, or hospitalization for heart failure) or all-cause death (major adverse cardiac and cerebrovascular events [MACCEs]). The secondary outcomes were the individual components of the primary outcome. Results During a follow-up period of 146,749 person-years (median, 6.0 years), MACCEs occurred in 17,573 patients (59.2%). Higher medication burden was associated with progressively higher incidence of MACCEs (84.7, 107.2, 130.2, and 168.9 events per 1000 person-years in Q1–Q4, respectively). In a multivariable Cox proportional hazard model, the adjusted hazard ratios (95% confidence intervals) for the second, third, and highest quartiles were 1.05 (1.00 to 1.10), 1.12 (1.07 to 1.17), and 1.27 (1.21 to 1.33), respectively, compared with the lowest quartile. In continuous modeling, each increase in the number of medication was associated with a 1.03-fold (95% confidence interval, 1.03 to 1.04) higher risk of the primary outcome. Conclusion A high medication burden was independently associated with higher risk of adverse cardiovascular outcomes and all-cause death in patients receiving maintenance hemodialysis. These findings suggest that a high medication burden could be a useful indicator of adverse clinical outcomes in patients undergoing hemodialysis.
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Affiliation(s)
- Cheol Ho Park
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea
| | - Ye Eun Ko
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ga Young Heo
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea
| | - Bo Yeon Kim
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Seong Ju Oh
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - So Young Han
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Jung Tak Park
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyung Woo Kim
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea
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Liu X, Chen P, Liu Y, Jia X, Xu D. Medication burden in patients with dialysis-dependent CKD: a systematic review. Ren Fail 2024; 46:2353341. [PMID: 38832502 DOI: 10.1080/0886022x.2024.2353341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/06/2024] [Indexed: 06/05/2024] Open
Abstract
This systematic review aimed to statistically profile the medication burden and associated influencing factors, and outcomes in patients with dialysis-dependent chronic kidney disease (DD-CKD). Studies of medication burden in patients with DD-CKD in the last 10 years from 1 January 2013 to 31 March 2024 were searched from PubMed, Embase, and Cochrane databases. Newcastle-Ottawa Scale (NOS) or Agency for Healthcare Research and Quality (AHRQ) methodology checklist was used to evaluate quality and bias. Data extraction and combining from multiple groups of number (n), mean, and standard deviation (SD) were performed using R programming language (version4.3.1; R Core Team, Vienna, Austria). A total of 10 studies were included, and the results showed a higher drug burden in patients with DD-CKD. The combined pill burden was 14.57 ± 7.56 per day in hemodialysis (HD) patients and 14.63 ± 6.32 in peritoneal dialysis (PD) patients. The combined number of medications was 9.74 ± 3.37 in HD and 8 ± 3 in PD. Four studies described the various drug classes and their proportions, in general, antihypertensives and phosphate binders were the most commonly used drugs. Five studies mentioned factors associated with medication burden. A total of five studies mentioned medication burden-related outcomes, with one study finding that medication-related burden was associated with increased treatment burden, three studies finding that poor medication adherence was associated with medication burden, and another study finding that medication complexity was not associated with self-reported medication adherence. Limitations: meta-analysis was not possible due to the heterogeneity of studies.
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Affiliation(s)
- Xuemei Liu
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong First Medical University, Jinan, China
- Shandong Institute of Nephrology, Jinan, China
| | - Ping Chen
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Institute of Nephrology, Jinan, China
| | - Yun Liu
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Xiaoyan Jia
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Institute of Nephrology, Jinan, China
| | - Dongmei Xu
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Institute of Nephrology, Jinan, China
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Kirchmayer U, Marino C, Feriozzi S, Massimetti C, Manzuoli M, Angelici L, Bargagli AM, Cascini S, Addis A, Davoli M, Agabiti N. Drug utilization in patients starting haemodialysis with a focus on cardiovascular and antidiabetic medications: an epidemiological study in the Lazio region (Italy), 2016-2020. BMC Nephrol 2024; 25:98. [PMID: 38493085 PMCID: PMC10943891 DOI: 10.1186/s12882-024-03539-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Entering dialysis is a critical moment in patients' healthcare journey, and little is known about drug therapy around it. A study funded by the Italian Medicines Agency offered the opportunity to leverage data from the Lazio Regional Dialysis and Transplant Registry (RRDTL) and perform an observational study on drug use patterns before and after initiating chronic dialysis. METHODS Individuals initiating dialysis in 2016-2020 were identified from RRDTL, excluding patients with prior renal transplantation, stopping dialysis early, or dying within 12 months. Use of study drugs, predefined by clinicians, in the two years around the index date was retrieved from the drug claims register and described by semester. For each drug group, proportions of users (min 2 claims in 6 months) by semester, and intensity of treatment in terms of Defined Daily Doses (DDDs) for cardiovascular and antidiabetic agents were compared across semesters, stratifying by sex and age. RESULTS In our cohort of 3,882 patients we observed a general increase in drug use after initiating dialysis, with the mean number rising from 5.5 to 6.2. Cardiovascular agents accounted for the highest proportions, along with proton pump inhibitors and antithrombotics over all semesters. Dialysis-specific therapies showed the most evident increase, in particular anti-anaemics (iron 4-fold, erythropoietins almost 2-fold), anti-parathyroids (6-fold), and chelating agents (4-fold). Use of cardiovascular and antidiabetic drugs was characterised by significant variations in terms of patterns and intensity, with some differences between sexes and age groups. CONCLUSIONS Entering dialysis is associated with increased use of specific drugs and goes along with adaptations of chronic therapies.
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Grants
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
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Affiliation(s)
- Ursula Kirchmayer
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Claudia Marino
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy.
| | | | | | - Micol Manzuoli
- UOC Nephrology and Dialysis, ASL Viterbo, Viterbo, Italy
| | - Laura Angelici
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Anna Maria Bargagli
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Silvia Cascini
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Antonio Addis
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
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Khan BA, Qu X, Hua Y, Javaid MM. Real-World Experience of Using Etelcalcetide for Secondary Hyperparathyroidism in Community-Based Hemodialysis Centers in Singapore. Cureus 2023; 15:e48186. [PMID: 38050530 PMCID: PMC10693497 DOI: 10.7759/cureus.48186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/06/2023] Open
Abstract
Introduction Chronic kidney disease-related mineral and bone disorder (CKD-MBD), characterized by abnormalities in calcium, phosphate, and parathyroid hormone metabolism, with impaired bone turnover and extravascular calcification is a known complication of advanced chronic kidney disease (CKD). Secondary hyperparathyroidism (SHPT) develops early in the disease and its prevalence gradually increases with the disease progression, becoming almost universal in patients with end-stage renal disease (ESRD). The treatment for SHPT includes synthetic vitamin D analogs, calcitriol or calcimimetics. Recently, intravenous etelcalcetide was introduced as a second-generation calcimimetic. This article provides the real-world experience of using etelcalcetide in multiethnic Asian patients receiving hemodialysis at community-based hemodialysis centers in Singapore. Methods This study was real-world evidence, generated by a retrospective clinical audit of routine clinical care of hemodialysis patients in community-based centers in Singapore who received etelcalcetide for treating SHPT. The information on the starting and maximum dose of etelcalcetide, duration of treatment on hemodialysis, parathyroid hormone (PTH) levels, dialysate calcium, concomitant medications, and reasons for discontinuation were collected from the medical records. PTH levels were collected at four-, eight-, and twelve-month intervals. Results A total of 148 patients received etelcalcetide during the study period. Ten patients died and twenty discontinued their treatment, with 118 patients remaining on treatment. Demographically, the patients included Chinese, Malay, Indians, and those belonging to other racial groups. The starting dose of etelcalcetide ranged from 2.5 mg once per week to 7.5 mg three times a week. There was a 16.8% reduction (p=<0.001) in intact-PTH after four months of therapy. Target intact-PTH level of less than 60 pmol/L, was reported as 1.4% at baseline, with 22.3% at four months (p<0.001) and 25.9% at eight months (p=0.028). Calcium and phosphate levels were also tracked as part of the safety and efficacy measures of using etelcalcetide. No symptomatic hypocalcemia was noted and phosphate levels were noted to decline significantly. Overall, the calcium-phosphate product reduced at four months (13.2%, p=<0.001) and eight months (12.7%, p<0.05). An analysis of concomitant medication usage, dialysate calcium utilized, and the side effects of etelcalcetide were also recorded. Finally, a brief descriptive analysis of the patient's subjective feedback regarding etelcalcetide was also reported, especially regarding the reduction in pill burden and overall compliance to medications. Conclusion Etelcalcetide is safe and effective for treating SHPT in multi-ethnic Asian hemodialysis patients and can be considered an alternative to oral cinacalcet. Our study showed no side effects, which was one of the key reasons for non-compliance to traditional calcimimetics. A favorable compliance profile with reduced pill burden was noted by using this intravenous calcimimetic.
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Affiliation(s)
- Behram A Khan
- Medicine, National University of Singapore, Singapore, SGP
| | - XiaoJie Qu
- Medical Affairs, The National Kidney Foundation Singapore, Singapore, SGP
| | - Yan Hua
- Medical Affairs, The National Kidney Foundation Singapore, Singapore, SGP
| | - Muhammad M Javaid
- Medicine, Monash University, Melbourne, AUS
- Medicine, Deakin University, Warrnambool, AUS
- Nephrology, Woodlands Health, Singapore, SGP
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Ginsberg C, Ix JH. New Insights into the Effects of Etelcalcetide on Bone Health. Clin J Am Soc Nephrol 2023; 18:1388-1390. [PMID: 37791911 PMCID: PMC10637471 DOI: 10.2215/cjn.0000000000000316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Affiliation(s)
- Charles Ginsberg
- Division of Nephrology-Hypertension, University of California, San Diego, San Diego, California
| | - Joachim H. Ix
- Division of Nephrology-Hypertension, University of California, San Diego, San Diego, California
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
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9
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Beben T, Rifkin DE. The Life-Changing Magic of Tidying Up the Medication List. Clin J Am Soc Nephrol 2023; 18:1254-1256. [PMID: 37678835 PMCID: PMC10578622 DOI: 10.2215/cjn.0000000000000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Tomasz Beben
- Division of Nephrology, VA San Diego Healthcare System, San Diego, California, and University of California, San Diego, California
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10
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Hall RK, Muzaale AD, Bae S, Steal SM, Rosman LM, Segev DL, McAdams-DeMarco M. Association of Potentially Inappropriate Medication Classes with Mortality Risk Among Older Adults Initiating Hemodialysis. Drugs Aging 2023; 40:741-749. [PMID: 37378815 PMCID: PMC10441684 DOI: 10.1007/s40266-023-01039-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND AND OBJECTIVE Older adults initiating dialysis have a high risk of mortality and that risk may be related to potentially inappropriate medications (PIMs). Our objective was to identify and validate mortality risk associated with American Geriatrics Society Beers Criteria PIM classes and concomitant PIM use. METHODS We used US Renal Data System data to establish a cohort of adults aged ≥ 65 years initiating dialysis (2013-2014) and had no PIM prescriptions in the 6 months prior to dialysis initiation. In a development cohort (40% sample), adjusted Cox proportional hazards models were performed to determine which of 30 PIM classes were associated with mortality (or "high-risk" PIMs). Adjusted Cox models were performed to assess the association of the number of "high-risk" PIM fills/month with mortality. All models were repeated in the validation cohort (60% sample). RESULTS In the development cohort (n = 15,570), only 13 of 30 PIM classes were associated with a higher mortality risk. Compared with those with no "high-risk" PIM fills/month, patients having one "high-risk" PIM fill/month had a 1.29-fold (95% confidence interval 1.21-1.38) increased risk of death; those with two or more "high-risk" PIM fills/month had a 1.40-fold (95% confidence interval 1.24-1.58) increased risk. These findings were similar in the validation cohort (n = 23,569). CONCLUSIONS Only a minority of Beers Criteria PIM classes may be associated with mortality in the older dialysis population; however, mortality risk increases with concomitant use of "high-risk" PIMs. Additional studies are needed to confirm these associations and their underlying mechanisms.
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Affiliation(s)
- Rasheeda K Hall
- Department of Medicine, Duke University School of Medicine, Rasheeda Hall, 2424 Erwin Road, Suite 605, Durham, NC, 27705, USA.
- Durham Veterans Affairs Medical Center, Durham, NC, USA.
| | - Abimereki D Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, USA, MD
| | - Sunjae Bae
- Department of Surgery, New York University School of Medicine, New York City, NY, USA
| | - Stella M Steal
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lori M Rosman
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, New York University School of Medicine, New York City, NY, USA
| | - Mara McAdams-DeMarco
- Department of Surgery, New York University School of Medicine, New York City, NY, USA
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Yasuda H, Komatsu N, Ando J, Ando M. Hodgkin Lymphoma on Hemodialysis: A Review of Treatment and Recommendations. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:805-811. [PMID: 35948477 DOI: 10.1016/j.clml.2022.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/26/2022] [Accepted: 07/14/2022] [Indexed: 06/15/2023]
Abstract
Chemotherapy for classic Hodgkin lymphoma (cHL) patients on hemodialysis (HD) is an extremely challenging situation because pharmacokinetic and pharmacodynamic studies of most chemotherapeutics are lacking for the HD patient, and the small amount of evidence available comes mostly from case reports and small case series. In this review, we provide recommendations based on treatment experience of cHL patients on HD in the literature. HD patients undergoing chemotherapy are at risk of overdose and toxicities because many drugs are significantly eliminated by the kidneys, and at the same time, are at risk of undertreatment because many drugs are removed by HD. Therefore, dose modifications and timing of drug administration in relation to HD sessions must be carefully planned according to the distinct traits of each chemotherapeutic. We carried out an exhaustive literature review of reports of actual administrations of chemotherapeutics to cHL on HD, and also extrapolated data from reports of the same chemotherapeutics that were administered to HD patients with malignancies other than cHL. We summarized the information found in the literature, and provide practical and balanced recommendations concerning dose modifications and optimal timing of drug administration in relation to HD sessions for each chemotherapeutic. Chemotherapy regimens and individual chemotherapeutics studied in this review include ABVD (doxorubicin + bleomycin + vinblastine + dacarbazine), BEACOPP (bleomycin + etoposide + doxorubicin + cyclophosphamide + vincristine + procarbazine + prednisolone), MOPP (mechlorethamine + vincristine + procarbazine + prednisolone), gemcitabine, vinorelbine, brentuximab vedotin, and PD-1 inhibitors (nivolumab and pembrolizumab).
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Affiliation(s)
- Hajime Yasuda
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan.
| | - Norio Komatsu
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan; Laboratory for the Development of Therapies against MPN, Juntendo University School of Medicine, Tokyo, Japan; Department of Advanced Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Jun Ando
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan; Department of Cell Therapy and Transfusion Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Miki Ando
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
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