1
|
Baltzer Houlind M, Hansen L, Iversen E, Rasmussen HB, Larsen JB, Jørgensen S, Dalhoff K, Damkier P, Walls AB, Vermehren C, Andersen TRH, Kallemose T, Christrup L, Westergaard N. Pharmacogenetic testing of CYP2D6, CYP2C19 and CYP2C9 in Denmark: Agreement between publicly funded genotyping tests and the subsequent phenotype classification. Basic Clin Pharmacol Toxicol 2024; 134:756-763. [PMID: 38403838 DOI: 10.1111/bcpt.13990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Luise Hansen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Henrik Berg Rasmussen
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Roskilde, Denmark
| | | | - Steffen Jørgensen
- Centre for Engineering and Science, University College Absalon, Naestved, Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Per Damkier
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne B Walls
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Vermehren
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | | | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Lona Christrup
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
2
|
Iversen E, Christensen KM, Walls AB, Eickhoff MK, von Scholten BJ, Frimodt-Møller M, Hansen TW, Persson F, Rossing P, Rotbain Curovic V, Houlind MB. Performance of new and panel CKD-EPI equations in European adults with type 2 diabetes. Diabetes Obes Metab 2024. [PMID: 38449081 DOI: 10.1111/dom.15536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | | | - Anne Byriel Walls
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | | | - Bernt Johan von Scholten
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Novo Nordisk A/S, Data Science, Copenhagen, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | | | - Tine Willum Hansen
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Iversen E, Hornum M, Houlind MB. In Reply to Estimating GFR: The Devil Is in the Details. Am J Kidney Dis 2024; 83:268-269. [PMID: 37972815 DOI: 10.1053/j.ajkd.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Mads Hornum
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; The Capital Region Pharmacy, Herlev, Denmark; Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
4
|
Houlind MB, Andersen O, Iversen E. Cystatin C to Creatinine Ratio and Measured GFR in Hospitalized Older Adults. Am J Kidney Dis 2024:S0272-6386(24)00012-X. [PMID: 38224732 DOI: 10.1053/j.ajkd.2023.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 01/17/2024]
Affiliation(s)
- Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; The Capital Region Pharmacy, Herlev, Denmark; Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| |
Collapse
|
5
|
Iversen E, Hornum M, Houlind MB. Comparison of Measured and Estimated GFR for Rivaroxaban Dosing in Hospitalized Older Adults. Am J Kidney Dis 2024; 83:117-118. [PMID: 37678741 DOI: 10.1053/j.ajkd.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/21/2023] [Accepted: 07/15/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Mads Hornum
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; The Capital Region Pharmacy, Herlev, Denmark; Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
6
|
Iversen E, Bengaard AK, Leegaard Andersen A, Tavenier J, Nielsen RL, Juul-Larsen HG, Jørgensen LM, Bornæs O, Jawad BN, Aharaz A, Walls AB, Kallemose T, Dalhoff K, Nehlin JO, Hornum M, Feldt-Rasmussen B, Damgaard M, Andersen O, Houlind MB. Performance of Panel-Estimated GFR Among Hospitalized Older Adults. Am J Kidney Dis 2023; 82:715-724. [PMID: 37516299 DOI: 10.1053/j.ajkd.2023.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/16/2023] [Accepted: 05/10/2023] [Indexed: 07/31/2023]
Abstract
RATIONALE & OBJECTIVE Older adults represent nearly half of all hospitalized patients and are vulnerable to inappropriate dosing of medications eliminated through the kidneys. However, few studies in this population have evaluated the performance of equations for estimating the glomerular filtration rate (GFR)-particularly those that incorporate multiple filtration markers. STUDY DESIGN Cross-sectional diagnostic test substudy of a randomized clinical trial. SETTING & PARTICIPANTS Adults≥65 years of age presenting to the emergency department of Copenhagen University Hospital Amager and Hvidovre in Hvidovre, Denmark, between October 2018 and April 2021. TESTS COMPARED Measured GFR (mGFR) determined using 99mTc-DTPA plasma clearance compared with estimated GFR (eGFR) calculated using 6 different equations based on creatinine; 3 based on creatinine and cystatin C combined; and 2 based on panels of markers including creatinine, cystatin C, β-trace protein (BTP) and/or β2-microglobulin (B2M). OUTCOME The performance of each eGFR equation compared with mGFR with respect to bias, relative bias, inaccuracy (1-P30), and root mean squared error (RMSE). RESULTS We assessed eGFR performance for 106 patients (58% female, median age 78.3 years, median mGFR 62.9mL/min/1.73m2). Among the creatinine-based equations, the 2009 CKD-EPIcr equation yielded the smallest relative bias (+4.2%). Among the creatinine-cystatin C combination equations, the 2021 CKD-EPIcomb equation yielded the smallest relative bias (-3.4%), inaccuracy (3.8%), and RMSE (0.139). Compared with the 2021 CKD-EPIcomb, the CKD-EPIpanel equation yielded a smaller RMSE (0.136) but larger relative bias (-4.0%) and inaccuracy (5.7%). LIMITATIONS Only White patients were included; only a subset of patients from the original clinical trial underwent GFR measurement; and filtration marker concentration can be affected by subclinical changes in volume status. CONCLUSIONS The 2009 CKD-EPIcr, 2021 CKD-EPIcomb, and CKD-EPIpanel equations performed best and notably outperformed their respective full-age spectrum equations. The addition of cystatin C to creatinine-based equations improved performance, while the addition of BTP and/or B2M yielded minimal improvement. FUNDING Grants from public sector industry (Amgros I/S) and government (Capital Region of Denmark). TRIAL REGISTRATION Registered at ClinicalTrials.gov with registration number NCT03741283. PLAIN-LANGUAGE SUMMARY Inaccurate kidney function assessment can lead to medication errors, a common cause of hospitalization and early readmission among older adults. Several novel methods have been developed to estimate kidney function based on a panel of kidney function markers that can be measured from a single blood sample. We evaluated the accuracy of these new methods (relative to a gold standard method) among 106 hospitalized older adults. We found that kidney function estimates combining 2 markers (creatinine and cystatin C) were highly accurate and noticeably more accurate than estimates based on creatinine alone. Estimates incorporating additional markers such as β-trace protein and β2-microglobulin did not further improve accuracy.
Collapse
Affiliation(s)
- Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre.
| | - Anne Kathrine Bengaard
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Department of Clinical Medicine, University of Copenhagen, Copenhagen; Capital Region Pharmacy, Herlev, Denmark
| | - Aino Leegaard Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | | | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Lillian Mørch Jørgensen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Olivia Bornæs
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Baker Nawfal Jawad
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Anissa Aharaz
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Capital Region Pharmacy, Herlev, Denmark
| | - Anne Byriel Walls
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen; Capital Region Pharmacy, Herlev, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Jan Olof Nehlin
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Mads Hornum
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Morten Damgaard
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen; Capital Region Pharmacy, Herlev, Denmark
| |
Collapse
|
7
|
Iversen E, Andersen O, Houlind MB. Discordance in Estimated GFR Among Hospitalized Older Adults. Kidney Med 2023; 5:100743. [PMID: 38116165 PMCID: PMC10728693 DOI: 10.1016/j.xkme.2023.100743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Affiliation(s)
- Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
8
|
Houlind MB, Iversen E, Curovic VR, Jørgensen MB, Andersen A, Gustafsson F, Nelson LMS, Perch M, Damgaard M, Persson F, Feldt-Rasmussen B, Andersen O, Lund TM, Hornum M. Performance of the 2009 CKDEPI, 2021 CKDEPI, and EKFC equations among high-risk patients in Denmark. Clin Chem Lab Med 2023; 61:e192-e195. [PMID: 37094024 DOI: 10.1515/cclm-2023-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/09/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | | | - Morten Buss Jørgensen
- Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Aino Andersen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Michael Perch
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Morten Damgaard
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager & Hvidovre, Hvidovre, Denmark
| | | | - Bo Feldt-Rasmussen
- Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Emergency Department, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Trine Meldgaard Lund
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Mads Hornum
- Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
9
|
Iversen E, Walls AB, Petersen A, Jensen PS, Kallemose T, Andersen A, Nielsen RL, Bengaard AK, Juul-Larsen HG, Bornaes O, Damgaard M, Andersen O, Tavenier J, Houlind MB. Estimated glomerular filtration rate based on creatinine, cystatin C, β-trace protein and β2 microglobulin in patients undergoing nontraumatic lower extremity amputation. Br J Clin Pharmacol 2023; 89:1789-1798. [PMID: 36511684 DOI: 10.1111/bcp.15639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/28/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Abstract
AIMS The study's aim is to compare current and new equations for estimating glomerular filtration rate (GFR) based on creatinine, cystatin C, β-trace protein (BTP) and β2 microglobulin (B2M) among patients undergoing major amputation. METHODS This is a secondary analysis of data from a prospective cohort study investigating patients undergoing nontraumatic lower extremity amputation. Estimated GFR (eGFR) was calculated using equations based on creatinine (eGFRcre[2009] and eGFRcre[2021]), cystatin C (eGFRcys), the combination of creatinine and cystatin C (eGFRcomb[2012] and eGFRcomb[2021]) or a panel of all 4 filtration markers (eGFRpanel). Primary outcome was changed in eGFR across amputation according to each equation. Two case studies of prior amputation with GFR measured by 99mTc-DTPA clearance are described to illustrate the relative accuracies of each eGFR equation. RESULTS Analysis of the primary outcome included 29 patients (median age 75 years, 31% female). Amputation was associated with a significant decrease in creatinine concentration (-0.09 mg/dL, P = 0.004), corresponding to a significant increase in eGFRcre[2009] (+6.1 mL/min, P = 0.006) and eGFRcre[2021] (+6.3 mL/min, P = 0.006). Change across amputation was not significant for cystatin C, BTP, B2M or equations incorporating these markers (all P > 0.05). In both case studies, eGFRcre[2021] yielded the largest positive bias, eGFRcys yielded the largest negative bias and eGFRcomb[2012] and eGFRcomb[2021] yielded the smallest absolute bias. CONCLUSION Creatinine-based estimates were substantially higher than cystatin C-based estimates before amputation and significantly increased across amputation. Estimates combining creatinine and cystatin were stable across amputation, while the addition of BTP and B2M is unlikely to be clinically relevant.
Collapse
Affiliation(s)
- Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Anne Byriel Walls
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- The Capital Region Pharmacy, Herlev, Denmark
| | - Annamarie Petersen
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- The Capital Region Pharmacy, Herlev, Denmark
| | - Pia Søe Jensen
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
- The Research Unit of Orthopedic Nursing, Department of Orthopedic Surgery, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Aino Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Rikke Lundsgaard Nielsen
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Anne Kathrine Bengaard
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Olivia Bornaes
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Morten Damgaard
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Emergency Department, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- The Capital Region Pharmacy, Herlev, Denmark
| |
Collapse
|
10
|
Aharaz A, Kejser CL, Poulsen MW, Jeftic S, Ulstrup-Hansen AI, Jørgensen LM, Iversen E, Thorhauge AM, Houlind MB. Optimization of the Danish National Electronic Prescribing System to Improve Patient Safety: Development of a User-Friendly Prototype of the Digital Platform Shared Medication Record. Pharmacy (Basel) 2023; 11:pharmacy11020041. [PMID: 36961019 PMCID: PMC10037631 DOI: 10.3390/pharmacy11020041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/25/2023] Open
Abstract
This study uses a participatory design to develop a user-friendly prototype of the current Danish digital platform, Shared Medication Record (SMR), to improve patient safety and minimize medication errors for patients with multimorbidity. A fundamental challenge for medication prescribing is the lack of access to an accurate medication list, which impairs effective communication between healthcare professionals and increases the risk of medication errors. We used a participatory design to identify the major problems with the existing SMR and develop a prototype for a redesigned SMR that addresses these problems. We argue that this prototype will improve communication between healthcare providers, promote patient involvement in their own care, and ultimately reduce medication errors related to the SMR. Moreover, we argue that the participatory design with its emphasis on user involvement and design iterations is a strong approach when designing IT solutions for complex problems in healthcare.
Collapse
Affiliation(s)
- Anissa Aharaz
- The Capital Region Pharmacy, 2730 Herlev, Denmark
- Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, 2650 Copenhagen, Denmark
| | | | | | - Sara Jeftic
- Department of Communication, University of Copenhagen, 2300 Copenhagen, Denmark
| | | | - Lillian Mørch Jørgensen
- Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, 2650 Copenhagen, Denmark
- Emergency Department, Copenhagen University Hospital-Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, 2650 Copenhagen, Denmark
| | | | - Morten Baltzer Houlind
- The Capital Region Pharmacy, 2730 Herlev, Denmark
- Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, 2650 Copenhagen, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark
| |
Collapse
|
11
|
Iversen E, Boesby L, Hansen D, Houlind MB. Comparison of 24-hour urinary creatinine clearance and estimated glomerular filtration rate based on a panel of filtration markers in patients with chronic kidney disease. Pharmacol Res Perspect 2022; 10:e01002. [PMID: 36069238 PMCID: PMC9449817 DOI: 10.1002/prp2.1002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 11/22/2022] Open
Abstract
Diagnosis and management of chronic kidney disease (CKD) requires accurate assessment of glomerular filtration rate (GFR). In practice, GFR is typically estimated by equations based on creatinine concentration in blood, but creatinine is affected by non-GFR factors such as age and sex. Alternative filtration markers such as cystatin C, beta-trace protein (BTP), and beta-2 microglobulin (B2M) may be less dependent on age and sex, but equations combining these markers have not been investigated in patients with chronic kidney disease (CKD). In this cross-sectional study of 50 patients with CKD stage 3-4, we compared kidney function estimates based on creatinine, cystatin C, BTP, B2M, or a combination of markers. Compared to the creatinine/cystatin C combination equation, the panel equation yielded a mean difference of only 2.8 ml/min/1.73 m2 , indicating that switching to the panel equation would be unlikely to affect management.
Collapse
Affiliation(s)
- Esben Iversen
- Department of Clinical ResearchCopenhagen University Hospital Amager and HvidovreHvidovreDenmark
- Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Lene Boesby
- Department of NephrologyCopenhagen University Hospital Herlev and GentofteCopenhagenDenmark
- Department of Internal MedicineZealand University Hospital RoskildeRoskildeDenmark
| | - Ditte Hansen
- Department of NephrologyCopenhagen University Hospital Herlev and GentofteCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Morten Baltzer Houlind
- Department of Clinical ResearchCopenhagen University Hospital Amager and HvidovreHvidovreDenmark
- Capital Region PharmacyHerlevDenmark
- Department of Drug Design and PharmacologyUniversity of CopenhagenCopenhagenDenmark
| |
Collapse
|
12
|
Baltzer Houlind M, Iversen E, Andersen A, Juul-Larsen HG, Carlson N, Andersen O, Hornum M. Further perspectives on statin use in patients with chronic kidney disease. Basic Clin Pharmacol Toxicol 2022; 131:303-305. [PMID: 36028936 DOI: 10.1111/bcpt.13785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,The Capital Region Pharmacy, Herlev, Denmark.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Aino Andersen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Nicholas Carlson
- Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,Emergency Department, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mads Hornum
- Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Emergency Department, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| |
Collapse
|
13
|
Houlind MB, Iversen E, Jawad BN, Kallemose T, Hornum M. Machine Learning to Identify Patients at Risk of Inappropriate Dosing for Renal Risk Medications: A Critical Comment on Kaas-Hansen et al [Letter]. Clin Epidemiol 2022; 14:763-764. [PMID: 35707499 PMCID: PMC9190741 DOI: 10.2147/clep.s369602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,The Capital Region Pharmacy, Herlev, Denmark.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Emergency Department, Copenhagen University Hospital - Amager & Hvidovre, Hvidovre, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Baker Nawfal Jawad
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Mads Hornum
- Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
14
|
Iversen E, Chen J, Libin S, Solheim E, Vavik V, Schuster P. Pacemaker and AV node ablation after multiple AF ablation procedures: a patients perspective - The PANAMA PAPER. Europace 2022. [DOI: 10.1093/europace/euac053.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Objectives
The aim of this study was to assess the number of AF catheter ablations appropriate before decision of pacemaker implantation and AV node ablation.
Background
The main purpose of AF treatment strategy, including both therapies aimed to maintain sinus rhythm and therapies that control the rate, is symptomatic improvement. Complex decision-making is involved in the choice of strategy. Indication for AF catheter ablation is the presence of symptomatic paroxysmal or persistent AF. However, many patients suffer from arrhythmia recurrence. Atrioventricular (AV) node ablation is a therapeutic option when AF is refractory to other therapeutic options.
Methods
This is a retrospective study based on patients recruited from the local database at Haukeland university hospital. Criteria for inclusion were patients with highly symptomatic AF after two or more AF catheter ablations and finally pacemaker and AV node ablation. Symptomatic improvement and quality of life were assessed using modified European Heart Rhythm Association (mEHRA) classification and self-evaluation.
Results
A total 23 patients were included in the study. After repeated AF catheter ablations, 7 (30.4%) patients had improvement in mEHRA class, most often by one class (n = 6). The improvement after AV node ablation were more significant (6 patients by 1 mEHRA class, 7 by 2, 5 by 3). According to the self-evaluation after AV node ablation, 18 patients were satisfied with respect to quality of life. The number of hospitalization were reduced from more than 6 per year (n = 11) to zero (n = 17) per year. Only one patient, among the 12 with only two AF catheter ablations, would prefer further attempts at AF catheter ablation. Retrospectively, 7 out 11 patients with at least 3 AF catheter ablations had preferred earlier pacemaker implantation and AV node ablation.
Conclusion
AV node ablation after several AF catheter ablations is a good option according to patients experience. In selected groups, recognized to have lower clinical efficacy of pulmonary vein isolation, AV node ablation might be considered after 2 or 3 unsuccessful AF catheter ablations.
Collapse
Affiliation(s)
- E Iversen
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
| | - J Chen
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
| | - S Libin
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
| | - E Solheim
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
| | - V Vavik
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
| | - P Schuster
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
| |
Collapse
|
15
|
Iversen E, Bengaard AK, Andersen A, Kallemose T, Damgaard M, Hornum M, Feldt-Rasmussen B, Andersen O, Houlind MB. Performance of the Cockcroft-Gault, Modification of Diet in Renal Disease, and new Chronic Kidney Disease Epidemiology Collaboration equations without race in older acute medical patients. Kidney Int 2022; 101:1087-1088. [DOI: 10.1016/j.kint.2022.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 12/24/2022]
|
16
|
Iversen E, Hornum M, Lund TM, Houlind MB. Comment on Delanaye et al: Future perspectives regarding kidney function estimates and dose adjustments. Br J Clin Pharmacol 2022; 88:2998-2999. [PMID: 35118701 DOI: 10.1111/bcp.15195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/12/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Mads Hornum
- Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Trine Meldgaard Lund
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,The Capital Region Pharmacy, Herlev, Denmark
| |
Collapse
|
17
|
Andersen TS, Gemmer MN, Sejberg HRC, Jørgensen LM, Kallemose T, Andersen O, Iversen E, Houlind MB. Medicines Reconciliation in the Emergency Department: Important Prescribing Discrepancies between the Shared Medication Record and Patients’ Actual Use of Medication. Pharmaceuticals (Basel) 2022; 15:ph15020142. [PMID: 35215255 PMCID: PMC8877185 DOI: 10.3390/ph15020142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 12/05/2022] Open
Abstract
Medication reconciliation is crucial to prevent medication errors. In Denmark, primary and secondary care physicians can prescribe medication in the same electronic prescribing system known as the Shared Medication Record (SMR). However, the SMR is not always updated by physicians, which can lead to discrepancies between the SMR and patients’ actual use of medication. These discrepancies may compromise patient safety upon admission to the emergency department (ED). Here, we investigated (a) the occurrence of discrepancies, (b) factors associated with discrepancies, and (c) the percentage of patients accessible to a clinical pharmacist during pharmacy working hours. The study included all patients age ≥ 18 years who were admitted to the Hvidovre Hospital ED on three consecutive days in June 2020. The clinical pharmacists performed medicines reconciliation to identify prescribing discrepancies. In total, 100 patients (52% male; median age 66.5 years) were included. The patients had a median of 10 [IQR 7–13] medications listed in the SMR and a median of two [IQR 1–3.25] discrepancies. Factors associated with increased rate of prescribing discrepancies were age < 65 years, time since last update of the SMR ≥ 115 days, and patients’ self-dispensing their medications. Eighty-four percent of patients were available for medicines reconciliations during the normal working hours of the clinical pharmacist. In conclusion, we found that discrepancies between the SMR and patients’ actual medication use upon admission to the ED are frequent, and we identified several risk factors associated with the increased rate of discrepancies.
Collapse
Affiliation(s)
- Tanja Stenholdt Andersen
- The Capital Region Pharmacy, 2730 Herlev, Denmark; (T.S.A.); (M.N.G.); (H.R.C.S.)
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
| | - Mia Nimb Gemmer
- The Capital Region Pharmacy, 2730 Herlev, Denmark; (T.S.A.); (M.N.G.); (H.R.C.S.)
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
| | - Hayley Rose Constance Sejberg
- The Capital Region Pharmacy, 2730 Herlev, Denmark; (T.S.A.); (M.N.G.); (H.R.C.S.)
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
| | - Lillian Mørch Jørgensen
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
| | - Ove Andersen
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (L.M.J.); (O.A.)
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
| | - Morten Baltzer Houlind
- The Capital Region Pharmacy, 2730 Herlev, Denmark; (T.S.A.); (M.N.G.); (H.R.C.S.)
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (T.K.); (E.I.)
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-28-83-85-63
| |
Collapse
|
18
|
Iversen E, Kallemose T, Hornum M, Bengaard AK, Nehlin JO, Rasmussen LJH, Sandholdt H, Tavenier J, Feldt-Rasmussen B, Andersen O, Eugen-Olsen J, Houlind MB. OUP accepted manuscript. Clin Kidney J 2022; 15:1534-1541. [PMID: 35892012 PMCID: PMC9308102 DOI: 10.1093/ckj/sfac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Indexed: 11/12/2022] Open
Abstract
Background Methods Results Conclusions
Collapse
Affiliation(s)
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Mads Hornum
- Department of Nephrology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Kathrine Bengaard
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Capital Region Pharmacy, Herlev, Denmark
| | - Jan Olof Nehlin
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Line Jee Hartmann Rasmussen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Haakon Sandholdt
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Capital Region Pharmacy, Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
19
|
Houlind MB, Andersen O, Iversen E. Cystatin C and Estimation of GFR in the Emergency Department. Am J Nephrol 2022; 53:856-857. [PMID: 36446335 DOI: 10.1159/000528406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,The Capital Region Pharmacy, Herlev, Denmark.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| |
Collapse
|
20
|
Andersen AL, Houlind MB, Nielsen RL, Jørgensen LM, Treldal C, Damgaard M, Bengaard AK, Juul-Larsen HG, Laursen LB, Iversen E, Kruse M, Pedersen AML, Hornum M, Beck AM, Pedersen MM, Ankarfeldt MZ, Petersen J, Andersen O. Optimization of Nutrition And Medication (OptiNAM) for acutely admitted older patients: protocol for a randomized single-blinded controlled trial. Trials 2021; 22:616. [PMID: 34521465 PMCID: PMC8439057 DOI: 10.1186/s13063-021-05456-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 07/13/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Internationally, older patients (≥65 years) account for more than 40% of acute admissions. Older patients admitted to the emergency department (ED) are frequently malnourished and exposed to inappropriate medication prescribing, due in part to the inaccuracy of creatinine-based equations for estimated glomerular filtration rate (eGFR). The overall aims of this trial are to investigate: (1) the efficacy of a medication review (MED intervention) independent of nutritional status, (2) the accuracy of eGFR equations based on various biomarkers compared to measured GFR (mGFR) based on 99mTechnetium-diethylenetriaminepentaacetic acid plasma clearance, and (3) the efficacy of an individualized multimodal and transitional nutritional intervention (MULTI-NUT-MED intervention) in older patients with or at risk of malnutrition in the ED. METHODS The trial is a single-center block randomized, controlled, observer-blinded, superiority and explorative trial with two parallel groups. The population consists of 200 older patients admitted to the ED: 70 patients without malnutrition or risk of malnutrition and 130 patients with or at risk of malnutrition defined as a Mini Nutritional Assessment-Short Form score ≤11. All patients without the risk of malnutrition receive the MED intervention, which consists of a medication review by a pharmacist and geriatrician in the ED. Patients with or at risk of malnutrition receive the MULTI-NUT-MED intervention, which consists of the MED intervention in addition to, dietary counseling and individualized interventions based on the results of screening tests for dysphagia, problems with activities of daily living, low muscle strength in the lower extremities, depression, and problems with oral health. Baseline data are collected upon study inclusion, and follow-up data are collected at 8 and 16 weeks after discharge. The primary outcomes are (1) change in medication appropriateness index (MAI) score from baseline to 8 weeks after discharge, (2) accuracy of different eGFR equations compared to mGFR, and (3) change in health-related quality of life (measured with EuroQol-5D-5L) from baseline to 16 weeks after discharge. DISCUSSION The trial will provide new information on strategies to optimize the treatment of malnutrition and inappropriate medication prescribing among older patients admitted to the ED. TRAIL REGISTRATION ClinicalTrials.gov NTC03741283 . Retrospectively registered on 14 November 2018.
Collapse
Affiliation(s)
- Aino L Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Morten B Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,The Capital Region Pharmacy, Marielundsvej 25, 2730, Herlev, Denmark.,Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen Ø, Denmark
| | - Rikke L Nielsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Lillian M Jørgensen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark
| | - Charlotte Treldal
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,The Capital Region Pharmacy, Marielundsvej 25, 2730, Herlev, Denmark.,Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen Ø, Denmark
| | - Morten Damgaard
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark
| | - Anne Kathrine Bengaard
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.,The Capital Region Pharmacy, Marielundsvej 25, 2730, Herlev, Denmark
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark
| | - Louise Bolvig Laursen
- Department of Physio- and Occupational Therapy, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark
| | - Marie Kruse
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,Danish Centre for Health Economics, University of Southern Denmark, J.B. Winsløws Vej 9B, 5000, Odense C, Denmark
| | - Anne M L Pedersen
- Section of Oral Medicine and Pathology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Mads Hornum
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.,Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen Ø, Denmark
| | - Anne M Beck
- Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200, Copenhagen N, Denmark.,Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Borgmester Ib Juuls Vej 50, 2730, Herlev, Denmark
| | - Mette M Pedersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Mikkel Z Ankarfeldt
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,Copenhagen Phase IV unit (Phase4CPH), Center of Clinical Research and Prevention and Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Janne Petersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,Copenhagen Phase IV unit (Phase4CPH), Center of Clinical Research and Prevention and Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.,Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark. .,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark. .,Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.
| |
Collapse
|
21
|
Walls AB, Bengaard AK, Iversen E, Nguyen CN, Kallemose T, Juul-Larsen HG, Jawad BN, Hornum M, Andersen O, Eugen-Olsen J, Houlind MB. Utility of suPAR and NGAL for AKI Risk Stratification and Early Optimization of Renal Risk Medications among Older Patients in the Emergency Department. Pharmaceuticals (Basel) 2021; 14:843. [PMID: 34577543 PMCID: PMC8471084 DOI: 10.3390/ph14090843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 12/29/2022] Open
Abstract
Diagnosis of acute kidney injury (AKI) based on plasma creatinine often lags behind actual changes in renal function. Here, we investigated early detection of AKI using the plasma soluble urokinase plasminogen activator receptor (suPAR) and neutrophil gelatinase-sssociated lipocalin (NGAL) and observed the impact of early detection on prescribing recommendations for renally-eliminated medications. This study is a secondary analysis of data from the DISABLMENT cohort on acutely admitted older (≥65 years) medical patients (n = 339). Presence of AKI according to kidney disease: improving global outcomes (KDIGO) criteria was identified from inclusion to 48 h after inclusion. Discriminatory power of suPAR and NGAL was determined by receiver-operating characteristic (ROC). Selected medications that are contraindicated in AKI were identified in Renbase®. A total of 33 (9.7%) patients developed AKI. Discriminatory power for suPAR and NGAL was 0.69 and 0.78, respectively, at a cutoff of 4.26 ng/mL and 139.5 ng/mL, respectively. The interaction of suPAR and NGAL yielded a discriminatory power of 0.80, which was significantly higher than for suPAR alone (p = 0.0059). Among patients with AKI, 22 (60.6%) used at least one medication that should be avoided in AKI. Overall, suPAR and NGAL levels were independently associated with incident AKI and their combination yielded excellent discriminatory power for risk determination of AKI.
Collapse
Affiliation(s)
- Anne Byriel Walls
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (A.B.W.); (A.K.B.); (C.N.N.)
- The Capital Region Pharmacy, 2730 Herlev, Denmark
| | - Anne Kathrine Bengaard
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (A.B.W.); (A.K.B.); (C.N.N.)
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
| | - Camilla Ngoc Nguyen
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (A.B.W.); (A.K.B.); (C.N.N.)
- The Capital Region Pharmacy, 2730 Herlev, Denmark
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
| | - Baker Nawfal Jawad
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
- Emergency Department, Copenhagen University Hospital—Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Mads Hornum
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
- Department of Nephrology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
- Emergency Department, Copenhagen University Hospital—Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
| | - Morten Baltzer Houlind
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (A.B.W.); (A.K.B.); (C.N.N.)
- The Capital Region Pharmacy, 2730 Herlev, Denmark
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
| |
Collapse
|
22
|
Bengaard AK, Iversen E, Kallemose T, Juul-Larsen HG, Rasmussen LJH, Dalhoff KP, Andersen O, Eugen-Olsen J, Houlind MB. Using soluble urokinase plasminogen activator receptor to stratify patients for medication review in the emergency department. Br J Clin Pharmacol 2021; 88:1679-1690. [PMID: 34242432 DOI: 10.1111/bcp.14982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS To investigate whether the association between levels of medication use (including polypharmacy and potentially inappropriate medications [PIMs]) and health outcomes such as readmission and mortality is dependent on baseline soluble urokinase plasminogen activator receptor (suPAR). METHODS This registry-based cohort study included medical patients admitted to the emergency department at Copenhagen University Hospital Hvidovre, Denmark. Patients were grouped according to their admission suPAR levels: low (0-3 ng/mL), intermediate (3-6 ng/mL), or high (>6 ng/mL). Hyper-polypharmacy was defined as ≥10 prescribed medications. PIMs were identified based on the EU(7)-PIM list, and data on admissions and mortality were obtained from national registries. Risk of 90-day readmission and mortality was assessed by Cox regression analysis adjusted for sex, age and Charlson comorbidity index. Results were reported as hazard ratios within 90 days of index discharge. RESULTS In total, 26 291 patients (median age 57.3 y; 52.7% female) were included. Risk of 90-day readmission and mortality increased significantly for patients with higher suPAR or higher number of medications. Among patients with low suPAR, patients with ≥10 prescribed medications had a hazard ratio of 2.41 (95% confidence interval = 2.09-2.78) for 90-day readmission and 8.46 (95% confidence interval = 2.53-28.28) for 90-day mortality compared to patients with 0 medications. Patients with high suPAR generally had high risk of readmission and mortality, and the impact of medication use was less pronounced in this group. Similar, but weaker, association patterns were observed between suPAR and PIMs. CONCLUSION The association between levels of medication use and health outcomes is dependent on baseline suPAR.
Collapse
Affiliation(s)
- Anne Kathrine Bengaard
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,The Capital Region Pharmacy, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Line Jee Hartmann Rasmussen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Kim Peder Dalhoff
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Emergency Department, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,The Capital Region Pharmacy, Herlev, Denmark.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
23
|
Iversen E, Houlind MB, Kallemose T, Rasmussen LJH, Hornum M, Feldt-Rasmussen B, Hayek SS, Andersen O, Eugen-Olsen J. Elevated suPAR Is an Independent Risk Marker for Incident Kidney Disease in Acute Medical Patients. Front Cell Dev Biol 2020; 8:339. [PMID: 32596235 PMCID: PMC7303513 DOI: 10.3389/fcell.2020.00339] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/17/2020] [Indexed: 01/21/2023] Open
Abstract
Introduction Identifying patients at high risk of developing kidney disease could lead to early clinical interventions that prevent or slow disease progression. Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory biomarker thought to be involved in the pathogenesis and development of kidney disease. We aimed to determine whether elevated plasma suPAR measured at hospital admission is associated with incident kidney disease in patients presenting to the emergency department. Materials and Methods This was a retrospective registry-based cohort study performed at the Emergency Department of Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark. Patients were included in the study from November 2013 to March 2017 and followed until June 2017. Patients were excluded if they were diagnosed with kidney disease or died prior to index discharge. Plasma suPAR was measured at hospital admission, and the main outcome was time to incident kidney disease, defined by ICD-10 diagnosis codes for both chronic and acute kidney conditions. Association between suPAR and time to incident kidney disease was assessed by Cox proportional hazard regression analysis. Results In total, 25,497 patients (median age 58.1 years; 52.5% female) were admitted to the emergency department and followed for development of kidney disease. In multivariable Cox regression analysis adjusting for age, sex, eGFR, CRP, cardiovascular disease, hypertension, and diabetes, each doubling in suPAR at hospital admission was associated with a hazard ratio of 1.57 (95% CI: 1.38–1.78, P < 0.001) for developing a chronic kidney condition and 2.51 (95% CI: 2.09–3.01, P < 0.001) for developing an acute kidney condition. Discussion In a large cohort of acutely hospitalized medical patients, elevated suPAR was independently associated with incident chronic and acute kidney conditions. This highlights the potential for using suPAR in risk classification models to identify high-risk patients who could benefit from early clinical interventions. The main limitation of this study is its reliance on accurate reporting of ICD-10 codes for kidney disease.
Collapse
Affiliation(s)
- Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Hospital Pharmacy, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Line Jee Hartmann Rasmussen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Mads Hornum
- Department of Nephrology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Salim S Hayek
- Department of Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, United States
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| |
Collapse
|
24
|
Aakjær M, Houlind MB, Treldal C, Ankarfeldt MZ, S Jensen P, Andersen O, Iversen E, Christrup LL, Petersen J. Differences in Kidney Function Estimates Based on Creatinine and/or Cystatin C in Non-Traumatic Amputation Patients and Their Impact on Drug Prescribing. J Clin Med 2019; 8:jcm8010089. [PMID: 30646571 PMCID: PMC6351924 DOI: 10.3390/jcm8010089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/03/2019] [Accepted: 01/09/2019] [Indexed: 12/15/2022] Open
Abstract
Accurate kidney function estimates are necessary when prescribing renally-eliminated medications. Our objectives were to investigate how amputation affects estimated glomerular filtration rate (eGFR) and to determine if dosing recommendations differ among different eGFR equations. In a cohort study of non-traumatic amputation patients, eGFR based on creatinine and/or cystatin C were measured before and after amputation. Prescribed, renally-eliminated medications were compared with dosing guidelines in Renbase®. Data from 38 patients with a median age of 75 years were analyzed. The median (range) eGFR was 65 (15⁻103), 38 (13⁻79), and 48 (13⁻86) mL/min/1.73 m² before amputation and 80 (22⁻107), 51 (13⁻95), and 62 (16⁻100) mL/min/1.73 m² after amputation for eGFRCreatinine, eGFRCystatinC, and eGFRCombined, respectively (p < 0.01). From before to after amputation, eGFR increased on average by 8.5, 6.1, and 7.4 mL/min/1.73 m² for eGFRCreatinine, eGFRCystatinC, and eGFRCombined (all p < 0.01), respectively. At least one renally-eliminated medication was prescribed at a higher dose than recommended in 37.8% of patients using eGFRCystatinC, 17.6% using eGFRCombined and 10.8% using eGFRCreatinine. In conclusion, amputation affects eGFR regardless of the eGFR equations. The differences among equations would impact prescribing of renally-eliminated medications, particularly when switching from creatinine to cystatin C.
Collapse
Affiliation(s)
- Mia Aakjær
- Clinical Research Centre, Copenhagen University Hospital, 2650 Hvidovre, Denmark.
- Section of Pharmacotherapy, Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark.
- The Capital Regional Pharmacy, 2730 Herlev, Denmark.
| | - Morten B Houlind
- Clinical Research Centre, Copenhagen University Hospital, 2650 Hvidovre, Denmark.
- Section of Pharmacotherapy, Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark.
- The Capital Regional Pharmacy, 2730 Herlev, Denmark.
| | - Charlotte Treldal
- Clinical Research Centre, Copenhagen University Hospital, 2650 Hvidovre, Denmark.
- Section of Pharmacotherapy, Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark.
- The Capital Regional Pharmacy, 2730 Herlev, Denmark.
| | - Mikkel Z Ankarfeldt
- Clinical Research Centre, Copenhagen University Hospital, 2650 Hvidovre, Denmark.
- Center for Clinical Research and Prevention, Copenhagen University Hospital, 2000 Frederiksberg, Denmark.
| | - Pia S Jensen
- Clinical Research Centre, Copenhagen University Hospital, 2650 Hvidovre, Denmark.
- Department of Orthopaedic Surgery, Copenhagen University Hospital, 2650 Hvidovre, Denmark.
| | - Ove Andersen
- Clinical Research Centre, Copenhagen University Hospital, 2650 Hvidovre, Denmark.
- Emergency Department, Copenhagen University Hospital, 2650 Hvidovre, Denmark.
| | - Esben Iversen
- Clinical Research Centre, Copenhagen University Hospital, 2650 Hvidovre, Denmark.
| | - Lona L Christrup
- Section of Pharmacotherapy, Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark.
| | - Janne Petersen
- Clinical Research Centre, Copenhagen University Hospital, 2650 Hvidovre, Denmark.
- Center for Clinical Research and Prevention, Copenhagen University Hospital, 2000 Frederiksberg, Denmark.
- Section of Biostatistics, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark.
| |
Collapse
|
25
|
Iversen E, Bodilsen AC, Klausen HH, Treldal C, Andersen O, Houlind MB, Petersen J. Kidney function estimates using cystatin C versus creatinine: Impact on medication prescribing in acutely hospitalized elderly patients. Basic Clin Pharmacol Toxicol 2018; 124:466-478. [DOI: 10.1111/bcpt.13156] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/21/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Esben Iversen
- Clinical Research Centre Copenhagen University Hospital Hvidovre Denmark
- Department of Drug Design and Pharmacology University of Copenhagen Copenhagen Denmark
| | - Ann Christine Bodilsen
- Clinical Research Centre Copenhagen University Hospital Hvidovre Denmark
- Exercise and Health Roskilde Municipality Denmark
| | | | - Charlotte Treldal
- Clinical Research Centre Copenhagen University Hospital Hvidovre Denmark
- Capital Region Pharmacy Herlev Denmark
| | - Ove Andersen
- Clinical Research Centre Copenhagen University Hospital Hvidovre Denmark
- Emergency Department Copenhagen University Hospital Hvidovre Denmark
- Department of Clinical Medicine Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Morten Baltzer Houlind
- Clinical Research Centre Copenhagen University Hospital Hvidovre Denmark
- Department of Drug Design and Pharmacology University of Copenhagen Copenhagen Denmark
- Capital Region Pharmacy Herlev Denmark
| | - Janne Petersen
- Clinical Research Centre Copenhagen University Hospital Hvidovre Denmark
- Section of Biostatistics Department of Public Health University of Copenhagen Copenhagen Denmark
- Center for Clinical Research and Prevention Copenhagen University Hospital Frederiksberg Denmark
| |
Collapse
|
26
|
Couch FJ, Shimelis H, Hart SN, Moore RM, Thomas A, Lipton GB, Iversen E. Abstract GS4-06: Cancer risks and response to targeted therapy associated with BRCA2 variants of uncertain significance. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-gs4-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Germline genetic testing of individuals with a diagnosis of triple negative breast cancer, young age at diagnosis, or a family history of breast and/or ovarian cancer has led to the identification of many unique BRCA2 missense variants of uncertain significance (VUS). VUS in BRCA2 are predominantly missense mutations that have unclear relevance to breast, ovarian, and other cancers. Thus, patients found to have a germline BRCA2 VUS do not know if the variant is associated with high risks of these cancers similar to truncating mutations, intermediate risks more similar to CHEK2 mutations, or low risks of no clinical significance. Furthermore, it is unclear if germline BRCA2 VUS, or somatic VUS identified by tumor sequencing, are associated with hypersensitivity to selected DNA damaging and cross-linking agents.
Methods: We have used a homology directed repair (HDR) cell-based assay to characterize missense variants in the DNA binding domain (DBD) of BRCA2. The method has been validated using known pathogenic and known non-pathogenic BRCA2 missense variants and has 100% sensitivity (95% confidence interval (CI): 75.3%–100%) and 100% specificity (95% CI: 81.5%–100%) for pathogenic BRCA2 variants. A classifier of variant pathogenicity based on the mean and variances of the distributions of the HDR results of the known pathogenic and neutral variants has been established. We have also developed PARP inhibitor and cisplatin drug response assays for BRCA2 missense variants.
Results: Assessment of 207 BRCA2 missense variants, identified in public databases such as BRCA exchange and ClinVar, by the HDR assay identified 71 deleterious variants with >99% probability of pathogenicity, 116 neutral variants with >99% probability of neutrality, and 20 with hypomorphic activity and potentially intermediate risk. A combination of the functional data and sequence-based predictors of protein activity in a Bayesian prediction model resulted in classification of the deleterious variants as pathogenic cancer predisposing variants and the neutral variants as non-pathogenic with low clinical significance. The influence of the deleterious/pathogenic variants on PARPi and cisplatin response was also assessed.
Conclusion: The HDR assay is effective for characterization of BRCA2 VUS. The combination of functional data and in silico prediction models provides a robust tool for clinical annotation of BRCA2 VUS. HDR function of BRCA2 missense variants is strongly correlated with response to targeted therapy.
Citation Format: Couch FJ, Shimelis H, Hart SN, Moore RM, Thomas A, Lipton GB, Iversen E. Cancer risks and response to targeted therapy associated with BRCA2 variants of uncertain significance [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr GS4-06.
Collapse
Affiliation(s)
- FJ Couch
- Mayo Clinic, Rochester, MN; Duke University, Durham, NC
| | - H Shimelis
- Mayo Clinic, Rochester, MN; Duke University, Durham, NC
| | - SN Hart
- Mayo Clinic, Rochester, MN; Duke University, Durham, NC
| | - RM Moore
- Mayo Clinic, Rochester, MN; Duke University, Durham, NC
| | - A Thomas
- Mayo Clinic, Rochester, MN; Duke University, Durham, NC
| | - GB Lipton
- Mayo Clinic, Rochester, MN; Duke University, Durham, NC
| | - E Iversen
- Mayo Clinic, Rochester, MN; Duke University, Durham, NC
| |
Collapse
|
27
|
Schuster P, Packer E, Sandberg S, Iversen E, Bleie Ø, Hoff P. P487Pulmonary vein stenosis after ablation treated by stent implantation - long term outcome. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
28
|
Hart SN, Hoskin T, Shimelis H, Feng B, Lindor NM, Monteiro A, Iversen E, Goldgar DE, Suman V, Couch FJ. Abstract P2-02-03: Optimized prediction of deleterious missense mutations in BRCA1 and BRCA2 genes. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-02-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Approximately 15% of genetic screens for mutations in BRCA1 and BRCA2 identify Variants of Uncertain Significance (VUS). Primarily missense mutations, VUS are often difficult to interpret, leading to either uncertainty in how to properly counsel a patient or an unnecessary prophylactic surgery. Given the paucity of data for which missenses are classified as truly pathogenic, computational deleterious missense prediction (DMP) algorithms are used to predict whether a mutation is likely deleterious or neutral. Accuracy of DMPs can vary considerably and have only been calibrated on a relatively small number of missense mutations of demonstrable effect on protein function. In this study, the performance of 41 different DMPs was compared to functional data from 455 functionally characterized missense variants in BRCA1 and BRCA2. New optimized thresholds for classifying missense mutations as deleterious are presented for several existing models as well as a newly derived naïve voting method (NVM). The areas under the curve estimates for the NVM approach are between 0.889-0.922, much higher than previous methods. We estimate that the overall pathogenic potential of missense variants to be 6.8% for BRCA1 and 3.2% of BRCA2, but can be as high as 50% depending on protein location. Overall these results provide key insights into how to predict deleterious missense mutations in BRCA1 and BRCA2.
Citation Format: Hart SN, Hoskin T, Shimelis H, Feng B, Lindor NM, Monteiro A, Iversen E, Goldgar DE, Suman V, Couch FJ. Optimized prediction of deleterious missense mutations in BRCA1 and BRCA2 genes [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-02-03.
Collapse
Affiliation(s)
- SN Hart
- Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Mayo Clinic, Jacksonville, FL; Moffit Cancer Center, Tampa, FL; Duke, Durham, NC
| | - T Hoskin
- Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Mayo Clinic, Jacksonville, FL; Moffit Cancer Center, Tampa, FL; Duke, Durham, NC
| | - H Shimelis
- Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Mayo Clinic, Jacksonville, FL; Moffit Cancer Center, Tampa, FL; Duke, Durham, NC
| | - B Feng
- Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Mayo Clinic, Jacksonville, FL; Moffit Cancer Center, Tampa, FL; Duke, Durham, NC
| | - NM Lindor
- Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Mayo Clinic, Jacksonville, FL; Moffit Cancer Center, Tampa, FL; Duke, Durham, NC
| | - A Monteiro
- Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Mayo Clinic, Jacksonville, FL; Moffit Cancer Center, Tampa, FL; Duke, Durham, NC
| | - E Iversen
- Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Mayo Clinic, Jacksonville, FL; Moffit Cancer Center, Tampa, FL; Duke, Durham, NC
| | - DE Goldgar
- Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Mayo Clinic, Jacksonville, FL; Moffit Cancer Center, Tampa, FL; Duke, Durham, NC
| | - V Suman
- Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Mayo Clinic, Jacksonville, FL; Moffit Cancer Center, Tampa, FL; Duke, Durham, NC
| | - FJ Couch
- Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Mayo Clinic, Jacksonville, FL; Moffit Cancer Center, Tampa, FL; Duke, Durham, NC
| |
Collapse
|
29
|
Abstract
The roentgenologic course of postoperative discitis is described in 111 patients examined with laminar tomography. The earliest lesion was blurring of the end plate or minor destructions, leading to cavitation of the vertebral body. Mean time from operation to the first clinical symptoms was 3 weeks. Mean time from operation to first radiologic lesions was 2 months, from operation to maximal lesions 4 months, and to the first radiologic sign of healing 5.5 months. A follow-up study was carried out and the radiologic findings were compared to those of a matched control group. A significantly higher incidence of decrease in disc height, intercorporal fusion and major osteophytes was found in the discitis group. The usefulness of laminar tomography, CT, MRI and isotope studies in the diagnosis of discitis is discussed. It is concluded that laminar tomography is a good alternative, when MRI is not available.
Collapse
|
30
|
Frederiksen A, Lysgaard A, Iversen E, Jørgensen N, Schwarz P. BMI might be overestimated in elderly and old osteoporosis patients suffering vertebral fracture(s). Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
31
|
Berchuck A, Sfakianos G, Whitaker R, Levine D, Murphy S, Marks J, Iversen E. Frequency of the cancer genome atlas expression subtypes differs between early and advanced stage high grade serous ovarian cancers. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
32
|
Helgstrand F, Iversen E, Bech K. [Transanal endoscopic microsurgery. The latest 5 years' experience in Roskilde County]. Ugeskr Laeger 2007; 169:1784-8. [PMID: 17537353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Transanal endoscopic microsurgery (TEM) was developed by Gerhard Buess in 1983 as an alternative to traditional transanal surgery. The method has become more and more widespread in the treatment of benign as well as T1 rectum tumours. We have used the method for several years and we present our results in this paper. MATERIALS AND METHODS Retrospective examination of patient files from consecutive registered patients who underwent TEM in the period June 1999 to November 2004, in all 76 operations on 74 patients. RESULTS 49 patients had adenomas; both the recurrence and complication rate was 6%. Median follow-up period was 12 months (range 0-57). 15 had a T1 tumour removed; the recurrence rate was 15%. One had a serious complication. Median follow-up period was 12 months (range 3-36). Eight had a T2 tumour removed; the recurrence rate was 16%. One had a serious complication. Median follow-up period was 21 months (range 9-36). Two patients were treated for a T3 tumour as part of palliation. CONCLUSION Our results are comparative to the largest foreign data. The recurrence rate is on the same level as open as well as laparoscopic surgery and far less than traditional transanal surgery. The complication risks are on the same level as laparoscopic access and far less than open surgery. However, preoperative investigation has to be developed further. Research is needed to clarify if selected patients with T2 cancer could be treated with TEM in combination with radiotherapy.
Collapse
|
33
|
Calvo N, Iversen E, Munck LK. [Intestinal side effects of COX-2 inhibitors]. Ugeskr Laeger 2006; 168:1343-4. [PMID: 16579892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
COX-2 inhibitors and NSAIDs have similar analgesic, anti-inflammatory and severe upper intestinal side effects. Adding to the sparse and casuistic reports, a further five cases of severe lower intestinal illness associated with COX-2 inhibitor ingestion are presented. Diarrhoea due to microscopic colitis was associated with short-time ingestion of refecoxib and celecoxib by two patients. Refecoxib intake for two months was associated with spontaneous perforation of a well-functioning J-pouch in a patient with ulcerative colitis. Intake of celecoxib and etodolac was associated with colonic ulceration and stricture. Side effects related to COX-2 inhibitors are similar to those related to NSAIDs.
Collapse
Affiliation(s)
- Nadia Calvo
- Medicinsk Afdeling, Roskilde Amts Sygehus Køge, DK-4600 Køge.
| | | | | |
Collapse
|
34
|
Johnson DB, Rolfe S, Hallberg KB, Iversen E. Isolation and phylogenetic characterization of acidophilic microorganisms indigenous to acidic drainage waters at an abandoned Norwegian copper mine. Environ Microbiol 2001; 3:630-7. [PMID: 11722543 DOI: 10.1046/j.1462-2920.2001.00234.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The biodiversity of culturable acidophilic microbes in three acidic (pH 2.7-3.7), metal-rich waters at an abandoned subarctic copper mine in central Norway was assessed. Acidophilic bacteria were isolated by plating on selective solid media, and dominant isolates were identified from their physiological characteristics and 16S rRNA gene sequences. The dominant iron-oxidizing acidophile in all three waters was an Acidithiobacillus ferrooxidans-like eubacterium, which shared 98% 16S rDNA identity with the type strain. A strain of Leptospirillum ferrooxidans was obtained from one of the waters after enrichment in pyrite medium, but this iron oxidizer was below detectable levels in the acidic waters themselves. In two sites, there were up to six distinct heterotrophic acidophiles, present at 10(3) ml(-1). These included Acidiphilium-like isolates (one closely related to Acidiphilium rubrum, a second to Acidiphilium cryptum and a third apparently novel isolate), an Acidocella-like isolate (96% 16S rDNA identity to Acidocella facilis) and a bacterium that shared 94.5% 16S rDNA identity to Acidisphaera rubrifaciens. The other numerically significant heterotrophic isolate was not apparently related to any known acidophile, with the closest match (96% 16S rDNA sequence identity) to an acetogen, Frateuria aurantia. The results indicated that the biodiversity of acidophilic bacteria, especially heterotrophs, in acidic mine waters may be much greater than previously recognized.
Collapse
Affiliation(s)
- D B Johnson
- School of Biological Sciences, University of Wales, Bangor LL57 2UW, UK.
| | | | | | | |
Collapse
|
35
|
Gramstad A, Iversen E, Engelsen BA. The impact of affectivity dispositions, self-efficacy and locus of control on psychosocial adjustment in patients with epilepsy. Epilepsy Res 2001; 46:53-61. [PMID: 11395289 DOI: 10.1016/s0920-1211(01)00261-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The main hypothesis of this study was that negative and positive affectivity, self-efficacy and health-related locus of control are important for psychosocial adjustment in patients with epilepsy. These dimensions are rarely examined directly in relation to the psychosocial adjustment in these patients. Correlations between measures of these constructs and measures of psychosocial adjustment in epilepsy were investigated. One hundred and one patients answered the Washington psychosocial seizure inventory (WPSI), the positive and negative affect schedule (PANAS-X), the multidimensional health locus of control scales (MHLC), the generalized self-efficacy scale and a scale measuring self-efficacy in epilepsy. Reliability analyses, correlational analyses and multiple stepwise regression analyses were performed. Negative affectivity (NA), positive affectivity (PA) and generalized self-efficacy showed high correlations with the WPSI scales emotional adjustment, overall psychosocial adjustment and quality of life. The epilepsy self-efficacy measures showed high, but lower correlations with the same WPSI scales. The MHLC scales showed low correlations with the WPSI scales. Multiple regression analyses showed that PA, NA and measures of self-efficacy explained more than 50% of the variances on emotional adjustment, overall psychosocial functioning and quality of life. In conclusion, positive and negative affectivity and self-efficacy are important predictors of perceived emotional adjustment, psychosocial adjustment and quality of life in patients with epilepsy. NA is the best predictor, but PA and self-efficacy measures give unique predictions independent of NA.
Collapse
Affiliation(s)
- A Gramstad
- Department of Neurology, Haukeland University Hospital, University of Bergen, N-5021 Bergen, Norway.
| | | | | |
Collapse
|
36
|
Laurberg P, Pedersen KM, Hreidarsson A, Sigfusson N, Iversen E, Knudsen PR. Iodine intake and the pattern of thyroid disorders: a comparative epidemiological study of thyroid abnormalities in the elderly in Iceland and in Jutland, Denmark. J Clin Endocrinol Metab 1998; 83:765-9. [PMID: 9506723 DOI: 10.1210/jcem.83.3.4624] [Citation(s) in RCA: 216] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Thyroid abnormalities are common in all populations, but it is difficult to compare results of epidemiological studies, because different methods have been used for evaluation. We studied the importance of the population iodine intake level for the prevalence rate of various thyroid abnormalities in elderly subjects. Random samples of elderly subjects (68 yr) were selected from the central person registers in Jutland, Denmark, with low (n = 423) and, in Iceland, with longstanding relatively high (n = 100) iodine intake. Females from Jutland had a high prevalence of goiter or previous goiter surgery (12.2%), compared with males from Jutland (3.2%) and females (1.9%) and males (2.2%) from Iceland. Abnormal thyroid function was very common in both areas, with serum TSH outside the reference range in 13.5% of subjects from Jutland and 19% of those from Iceland. In Jutland, it was mainly thyroid hyperfunction (9.7% had low, 3.8% had high serum TSH), whereas in Iceland, it was impaired thyroid function (1% had low, 18% had high serum TSH). All subjects with serum TSH more than 10 mU/L had autoantibodies in serum, but antibodies were, in general, more common in Jutland than in Iceland. Thus, thyroid abnormalities in populations with low iodine intake and those with high iodine intake develop in opposite directions: goiter and thyroid hyperfunction when iodine intake is relatively low, and impaired thyroid function when iodine intake is relatively high. Probably, mild iodine deficiency partly protects against autoimmune thyroid disease. Thyroid autoantibodies may be markers of an autoimmune process in the thyroid or secondary to the development of goiter.
Collapse
Affiliation(s)
- P Laurberg
- Department of Endocrinology and Internal Medicine, Aalborg Hospital, Denmark
| | | | | | | | | | | |
Collapse
|
37
|
Nørregaard J, Jørgensen S, Mikkelsen KL, Tønnesen P, Iversen E, Sørensen T, Søeberg B, Jakobsen HB. The effect of ephedrine plus caffeine on smoking cessation and postcessation weight gain. Clin Pharmacol Ther 1996; 60:679-86. [PMID: 8988071 DOI: 10.1016/s0009-9236(96)90217-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To evaluate the efficacy of a combination of ephedrine and caffeine on smoking cessation rates, postcessation weight gain, and withdrawal symptoms and to examine changes in glycosylated hemoglobin (HbA1c) after smoking cessation. METHODS This randomized double-blind placebo-controlled study with a 1-year follow-up period was carried out at the Department of Pulmonary Medicine in Denmark. Study subjects were 225 heavy smokers who wanted to quit smoking without gaining weight. Two-thirds of the subjects were randomized to receive 20 mg ephedrine plus 200 mg caffeine three times a day; one-third of the subjects received placebo treatment. The dosage was gradually decreased from week 12 to discontinuation at week 39. Group support and control were performed at entry and after 1, 3, 6, 12, 26, 39, and 52 weeks. Main outcome measures were (1) self-reported abstinence with validation by carbon monoxide in expired air and serum cotinine and (2) weight gain. RESULTS The success rates after 1 year were 17% in the group treated with ephedrine plus caffeine and 16% in the group treated with placebo; the success rates were not significantly different at any time. The success rates for the four counseling physicians varied between 7% and 27% after 1 year (p < 0.05). The weight gain was significantly lower in the ephedrine plus caffeine-treated group during the first 12 weeks, but weight gains were similar after 1 year. No differences in the smoking withdrawal symptoms could be observed between the treatment groups. HbA1c was lower 6 weeks and 1 year after smoking cessation (p < 0.05). CONCLUSIONS We found an effect of this combination of ephedrine and caffeine on weight gain during the first 12 weeks, but we found no effect on the success rates or craving for cigarettes.
Collapse
Affiliation(s)
- J Nørregaard
- Department of Pulmonary Medicine P, Bispebjerg Hospital, Copenhagen, Denmark
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Iversen E. Thyrotropin releasing hormone. Occurrence and role outside the central nervous system. Dan Med Bull 1995; 42:257-68. [PMID: 7587403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- E Iversen
- Department of Internal Medicine, Arhus Kommunehospital
| |
Collapse
|
39
|
Langer SW, Iversen E, Vestbo J, Viskum K. Electrocardiographic changes in patients with intrathoracic sarcoidosis: influence on prognosis. Sarcoidosis 1995; 12:42-5. [PMID: 7617975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A retrospective evaluation of 244 electrocardiograms obtained at rest at time of diagnosis from a population of 254 patients with intrathoracic sarcoidosis was carried out. Thirty-five (14%) were abnormal. Sinus tachycardia was present in 17 (7%), the rest encompassing various degrees of right-sided bundle branch, atrioventricular first degree block, ventricular extrasystolia and ST-depression. At follow-up after a median time of 27 years we found a significantly higher mortality risk in the group with ECG-changes compared to those without. Excess mortality was increased when comparing patients with tachycardia to those without. However, when adjusted for FEV1, the risk of death was not significantly different between the two groups.
Collapse
Affiliation(s)
- S W Langer
- Department of Pulmonary Medicine P, Bispebjerg Hospital, Copenhagen, Denmark
| | | | | | | |
Collapse
|
40
|
Pedersen KM, Iversen E, Laurberg P. Urinary iodine excretion and individual iodine supplementation among elderly subjects: a cross-sectional investigation in the commune of Randers, Denmark. Eur J Endocrinol 1995; 132:171-4. [PMID: 7858735 DOI: 10.1530/eje.0.1320171] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Several studies have demonstrated that the iodine intake is relatively low in Denmark. However, the results are difficult to interpret because no information has been given on the frequency of individual iodine supplementation. We performed a cross-sectional study of elderly subjects living in the commune of Randers, Denmark. Urinary iodine excretion was measured in the 423 participants (185 males, 238 females) and a careful history was taken on any possible intake of supplementary iodine. The median urinary iodine excretion was 48.3 micrograms/g creatinine for the whole population (40.8 micrograms/g creatinine in males, 53.2 micrograms/g creatinine in females). In the part of the population that did not take iodine supplementation (46.7%) the median value was 36.1 micrograms/g creatinine (males 33.8; females 38.8). Regular iodine supplementation taken as an iodine-containing vitamin/mineral tablet was found in 30.8% of the population. This increased the urinary iodine excretion to a median level of 80.5 micrograms/g creatinine (males 62.0; females 88.0). The study shows that the basic iodine intake level is overestimated if individual iodine supplementation is not taken into account. Such supplementation may lead to median iodine excretion values that seem reasonable, even if the iodine intake of the part of the population not taking iodine (in this study, nearly half of the population) is low.
Collapse
Affiliation(s)
- K M Pedersen
- Department of Internal Medicine and Endocrinology, Aalborg Hospital, Denmark
| | | | | |
Collapse
|
41
|
Pedersen KM, Laurberg P, Iversen E, Knudsen PR, Gregersen HE, Rasmussen OS, Larsen KR, Eriksen GM, Johannesen PL. Amelioration of some pregnancy-associated variations in thyroid function by iodine supplementation. J Clin Endocrinol Metab 1993; 77:1078-83. [PMID: 8408456 DOI: 10.1210/jcem.77.4.8408456] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Knowledge of the effect of differences in iodine intake levels on public health in areas with no endemic goiter is limited. Groups at risk when iodine intake is relatively low are pregnant and lactating women and their newborns. A prospective randomized study was performed to evaluate the effect of iodine supplementation in an area where the median daily iodine excretion in urine is around 50 micrograms. Fifty-four normal pregnant women were randomized to be controls or to receive 200 micrograms iodine/day from weeks 17-18 of pregnancy until 12 months after delivery. In the control group, serum TSH, serum thyroglobulin (Tg), and thyroid size showed significant increases during pregnancy. These variations were ameliorated by iodine supplementation. Iodine did not induce significant variations in serum T4, T3, or free T4. Cord blood Tg was much lower when the mother had received iodine, whereas TSH, T4, T3, and free T4 levels were unaltered. The results suggest that a relatively low iodine intake during pregnancy leads to thyroidal stress, with increases in Tg release and thyroid size. However, the thyroid gland is able to adapt and keep thyroid hormones in the mother and the child normal, at least under normal circumstances, as evaluated in the present study. It is not known whether this stress is sufficient to be of importance for late development of autonomous thyroid growth and function.
Collapse
Affiliation(s)
- K M Pedersen
- Department of Internal Medicine, Randers Hospital, Aalborg, Denmark
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Hildebrandt P, Torp-Pedersen C, Joen T, Iversen E, Jensen G, Jeppesen D, Melchior T, Schytten HJ, Ringsdal V, Jensen J. Reduced infarct size in nonreperfused myocardial infarction by combined infusion of isosorbide dinitrate and streptokinase. Am Heart J 1992; 124:1139-44. [PMID: 1442478 DOI: 10.1016/0002-8703(92)90392-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The value of thrombolytic therapy in myocardial infarction is well established, while any beneficial effect of adjunct therapy is more uncertain. In a double-blind, randomized, parallel-group study the effect of combined intravenous infusions of streptokinase and isosorbide dinitrate (ISDN) on enzyme-estimated infarct size was investigated. One hundred consecutive patients with strong clinical and electrocardiographic suspicion of myocardial infarction, admitted to the coronary care unit within 8 hours after the onset of symptoms, were given a streptokinase infusion of 1.5 million units for 1 hour and a titrated dose of ISDN or placebo for 48 hours. From isoenzyme B of creatine kinase (CK-B) values measured every 4 hours, the infarct size was calculated and the possible presence of reperfusion was evaluated. The infarct size in patients receiving ISDN infusion was reduced (p = 0.04, one-sided test) compared with placebo. By subdividing the patients according to whether or not reperfusion had occurred, the infarct size appeared to be similar following ISDN and placebo in patients with reperfusion (419 versus 369 U/L), whereas the infarct size in patients not reperfused was markedly reduced after treatment with ISDN (223 versus 1320 U/L, p = 0.003). In conclusion, the present study demonstrates that the infarct size may be reduced by other means than reperfusion and it supports the use of combined infusion of thrombolytic agents and nitrates in patients with suspected myocardial infarction.
Collapse
Affiliation(s)
- P Hildebrandt
- Department of Cardiology, Glostrup Hospital, Hellerup, Denmark
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
111 cases of postoperative discitis during 1968-1986 were analyzed retrospectively. The diagnosis was confirmed by lumbar tomography. Low back pain appeared at an average of 16 days postoperatively. Laboratory findings were of minor value in the diagnosis since elevated ESR, white blood cell count, and body temperature were inconstant findings. Compared with a matched control group, there was a higher incidence of chronic low back pain and vocational handicap in the discitis patients. There was no difference in the consumption of analgetics, the subjective evaluation of the final outcome, spinal mobility or neurologic findings.
Collapse
Affiliation(s)
- E Iversen
- University of Copenhagen, Department of Radiology, Glostrup Hospital, Denmark
| | | | | |
Collapse
|
44
|
Bonven TF, Iversen E, Kragballe K. [Permanent hair loss after Kerion Celsi]. Ugeskr Laeger 1991; 153:3151-2. [PMID: 1957362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Kerion celsi is a deep dermatophytic infection of the scalp. The diagnosis is based on the characteristic clinical picture and is verified by examination for the fungus. Treatment consists of griseofulvin in a dosage of 10 mg/kg/day. The present article is a retrospective investigation of 18 patients with kerion celsi who had been treated in the Department of Dermatology in Marselisborg Hospital during the period 1978-1989. Sixteen out of the 18 patients were children. Twelve of the children were boys. A questionnaire investigation revealed that only five out of 18 patients had normal hair growth. We found a connection between the degree of severity of the alopecia and the age of the patient and the extent of the primary affection, respectively, so that low patient age and large primary affection result in a poorer prognosis. On the other hand, we have not found any connection between the latent period from the first appearance of symptoms and relevant treatment and the alopecia. Nor is there any evidence that treatment with systemic steroid is of significance for the prognosis.
Collapse
Affiliation(s)
- T F Bonven
- Hudafdelingen, Marselisborg Hospital, Arhus
| | | | | |
Collapse
|
45
|
Abstract
Of 98 hydroceles (mean volume 125 ml) in a consecutive series of 92 patients, treated initially by aspiration, 14% (mean volume 70 ml) were cured. The 76 recurring hydroceles (mean volume 146 ml) were then randomised to either antazoline sclerotherapy on an out-patient basis or surgery. Cure rates were 89 and 100%, respectively, at follow-up 6 months later. Operated patients were admitted for a mean duration of 2.5 days. The results indicated that aspiration alone was inadequate, and sclerotherapy is advocated as the first choice of treatment for hydrocele.
Collapse
Affiliation(s)
- J U Roosen
- Department of Surgery, Frederikssund Sygehus, Denmark
| | | | | | | |
Collapse
|
46
|
Laursen LC, Iversen E. [Use of antiasthmatic agents in Denmark during 1979-1989. Do we overuse antiasthmatic drugs?]. Ugeskr Laeger 1991; 153:1881-2. [PMID: 1862577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- L C Laursen
- Københavns Amts Sygehus i Glostrup, medicinsk afdeling C
| | | |
Collapse
|
47
|
Abstract
In view of recent reports suggesting that thyroid hormone control of TRH degradation occurs outside the central nervous system in animals, the effect of thyroid status on serum and tissue degradation of TRH in man was investigated. In six patients with hyperthyroidism and six patients with hypothyroidism, constant TRH infusions were carried out for determination of plasma clearance rate (PCR) and half-life of disappearance (t1/2) of TRH, with simultaneous determination of half-life of disappearance in serum in vitro (t1/2p). Using a kinetic model, this enabled the calculation of the half-life of disappearance in the extravascular tissue compartment (t1/2t). All patients were reinvestigated after they had become euthyroid. PCR, t1/2 and t1/2p were 22.1 +/- 3.4 ml/kg per min, 6.8 +/- 1.1 min and 17.3 +/- 6.7 min (means +/- S.D.) respectively in the euthyroid patients. The t1/2p was slightly but significantly prolonged during hyperthyroidism. The t1/2 was 5.6 min in the hyperthyroid patients compared with 9.4 min in the hypothyroid patients. The calculated t1/2t was 6.5 min in the euthyroid patients. In the patients with untreated hyperthyroidism, t1/2t was significantly reduced (22.7 +/- 10.7%; mean +/- S.D.), while it was considerably prolonged (41.1 +/- 24.6%) in patients with untreated hypothyroidism. The percentage reduction or prolongation of t1/2t was negatively correlated with the logarithm of the serum concentrations of thyroxine (r = 0.92) and tri-iodothyronine (r = 0.91) in the untreated patients. Thus, thyroid hormones induce alterations in the pharmacokinetics of TRH. This may partly be due to induction by thyroid hormones of membrane-bound pyroglutamyl aminopeptidase.
Collapse
Affiliation(s)
- E Iversen
- Second University Clinic of Internal Medicine, Kommunehospitalet, Aarhus, Denmark
| |
Collapse
|
48
|
Nielsen VA, Iversen E, Ahlgren P. Postoperative discitis. Radiology of progress and healing. Acta Radiol 1990; 31:559-63. [PMID: 2278777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The roentgenologic course of postoperative discitis is described in 111 patients examined with laminar tomography. The earliest lesion was blurring of the end plate or minor destructions, leading to cavitation of the vertebral body. Mean time from operation to the first clinical symptoms was 3 weeks. Mean time from operation to first radiologic lesions was 2 months, from operation to maximal lesions 4 months, and to the first radiologic sign of healing 5.5 months. A follow-up study was carried out and the radiologic findings were compared to those of a matched control group. A significantly higher incidence of decrease in disc height, intercorporal fusion and major osteophytes was found in the discitis group. The usefulness of laminar tomography, CT, MRI and isotope studies in the diagnosis of discitis is discussed. It is concluded that laminar tomography is a good alternative, when MRI is not available.
Collapse
Affiliation(s)
- V A Nielsen
- Department of Radiology, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark
| | | | | |
Collapse
|
49
|
Iversen E, Schmitz O, Laurberg P. Turnover of thyrotropin-releasing hormone in patients with chronic renal failure and chronic alcoholic liver disease. Acta Endocrinol (Copenh) 1990; 123:179-84. [PMID: 2120878 DOI: 10.1530/acta.0.1230179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Homogenates of liver and kidney tissues are efficient in degrading TRH, but the liver contains only membrane-bound pyroglutamyl aminopeptidase, active in degrading TRH at the extracellular side of cell membranes. In the present study the effect of liver and kidney failure on the degradation of infused TRH was investigated in man. In 7 uremic patients (group I) and 7 patients with chronic alcoholic liver disease (group II) plasma clearance rate, half-time of disappearance (t1/2) and half time of disappearance of TRH in serum in vitro (t1/2p) was determined. The plasma clearance rate, t1/2 and t1/2p were, respectively, 19.8 +/- 6.2 ml.kg-1.min-1, 6.6 +/- 1.5 min and 16.4 +/- 6.2 min in group I versus 28.2 +/- 4.8 ml.kg-1.min-1, 9.3 +/- 2.6 min and 25.3 +/- 15 min (mean +/- SD) in group II. The volume of distribution of TRH was 19.3% of the body weight in group I and 36.5% in group II. The calculated half-time in the extravascular tissue compartment (t1/2) was 5.4 +/- 1.4 min in group I and 9.2 +/- 2.7 min in group II patients (mean +/- SD). TRH metabolism in the uremic patients was almost identical to that previously reported in normal subjects. In the patients with chronic liver disease plasma clearance rate was significantly greater than in normal subjects, indicating an increased TRH-degrading enzyme activity in the tissue compartment. However, owing to the very large expansion of this compartment, the t1/2 and t1/2t were significantly prolonged. Hence, half-time determination of TRH is no reliable indicator of overall TRH degradation in patients with liver disease.
Collapse
Affiliation(s)
- E Iversen
- II University Clinic of Internal Medicine, Kommunehospitalet, Aarhus, Denmark
| | | | | |
Collapse
|
50
|
Abstract
In the reported case history, a normotensive and non-diabetic patient with ischaemic heart disease was treated twice with diltiazem. On both occasions diabetes mellitus developed within a few days; at first this was fully reversible, but on the last occasion it was irreversible.
Collapse
Affiliation(s)
- E Iversen
- Department of Internal Medicine C, Glostrup Hospital, University of Copenhagen, Denmark
| | | | | |
Collapse
|