Strategies for postmarketing surveillance of drugs and devices in patients with ESRD undergoing dialysis

Nutritional intervention in end-stage renal disease: a clinical trial study

Objective

Chronic kidney disease is a global health problem, and end-stage renal disease (ESRD) has a major impact on patients' quality of life and prognoses. However, studies on individualized nutritional therapy for patients with ESRD need more complementary evidence.

Methods

A clinical study was conducted based on a small population. It included patients with ESRD who underwent dialysis treatment in the Taicang Hospital Department of Nephrology, Soochow University, China, between January 2019 and December 2021. According to the randomized number table method, patients were divided into the nutritional treatment group (NIG) and the non-nutritional intervention control group (NNIG). There were 84 patients in the NIG and 92 patients in the NNIG. This study analyzed the changes in residual renal function (RRF) and indicators of blood and kidney function in ESRD with personalized nutritional therapy.

Results

The results show that nutritional interventions for ESRD are effective in reducing the rate of decline in RRF and improving indicators of blood and kidney function in patients with ESRD. It was also found that patients with diabetes mellitus gained fewer health benefits per unit of RRF improvement with individualized nutritional therapy.

Conclusion

This study provides important information about the treatment effects and factors associated with individual nutritional interventions in a population with ESRD. These results contribute to a better understanding of the effects of nutritional therapy in ESRD and provide a basis for managing it. Further studies should focus on specific populations and potential interventions to improve patient prognosis.

Strength of evidence for labeled dosing recommendations in renal impairment

BACKGROUND/AIMS

Renally excreted medications often require dose adjustment in patients with kidney impairment. While drug development and approval in the United States are typically based on several Phase I and II studies and one or more larger Phase III randomized trials, the basis for labeled dosing recommendations for patients with renal impairment is less well known. In response, we aimed to quantify the level of evidence used to recommend labeled dosing adjustments for newly approved drugs in patients with renal impairment.

METHODS

We reviewed publicly available drug labels and approval packages for new molecular entities approved in the United States between 2012 and 2014. The sample was restricted to 29 renally excreted new molecular entities that were not granted orphan drug status. We extracted data regarding approved indications, normal dosing, dosing adjustments for patients with mild (estimated glomerular filtration rate >60 mL/min/1.73 m²), moderate (estimated glomerular filtration rate 30-<60 mL/min/1.73 m²), and severe (estimated glomerular filtration rate <30 mL/min/1.73 m²) renal impairment, characteristics of studies used to justify dosing adjustments, and numbers of subjects in each study.

RESULTS

In all, 14 of 29 (48%) new molecular entities had labels that recommended dosing adjustments for patients with mild, moderate, and/or severe renal impairment. Among these 14 new molecular entities, 4 (29%) used only pharmacokinetic studies to justify the recommendations, with no examination of clinical outcomes for patients with renal impairment. Where data were available, the median number of patients with renal impairment evaluated in studies used for dosing adjustment was 34 (range, 4-5976). Of the 15 new molecular entities with no recommended dosing adjustments for this population, 2 (13%) did not report assessing the effects of renal impairment.

CONCLUSION

Nearly half of newly approved renally excreted drugs include dosing adjustments for kidney impairment on the label, but the recommendations are usually based on very small numbers of patients and often utilize pharmacokinetic studies alone. More research is needed to understand the benefits and risks of new drugs in patients with renal impairment.