Publications by authors named "David Leaf"
Article Synopsis
- High-dose methotrexate (MTX) can lead to serious complications like acute kidney injury (AKI), neutropenia, and liver damage, but glucarpidase, an enzyme that breaks down MTX, shows potential benefits.
- In a study of 708 patients with MTX-AKI across 28 cancer centers, those receiving glucarpidase had a significantly higher chance of kidney recovery and faster recovery times compared to those who did not receive the treatment.
- Additionally, glucarpidase treatment was associated with lower rates of severe neutropenia and liver enzyme elevation, but there was no notable difference in mortality rates between the two groups.
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of cancer and are now the backbone of therapy for several malignancies. However, ICIs can cause a spectrum of kidney immune-related adverse events including acute kidney injury (AKI), most commonly manifesting as acute interstitial nephritis (AIN), although glomerular disease and electrolyte disturbances have also been reported. In this position statement by the American Society of Onco-nephrology (ASON), we summarize the incidence and risk factors for ICI-AKI, pathophysiological mechanisms, and clinicopathologic features of ICI-AKI.
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- Erythropoietic protoporphyria (EPP) and X-linked protoporphyria (XLP) are rare conditions causing severe skin reactions to sunlight, and afamelanotide is the only approved treatment that enhances light tolerance and quality of life (QoL).
- A study conducted at Massachusetts General Hospital evaluated 29 adults who received afamelanotide, showing that patients experienced significant increases in time before phototoxic symptoms appeared after sunlight exposure, indicating improved light tolerance.
- Despite these benefits in light tolerance and QoL, the treatment did not result in improvements in laboratory markers of protoporphyria or liver function.
Background: Creatinine-based estimated glomerular filtration rate (eGFR) may overestimate kidney function in patients with sarcopenia. While cystatin C-based eGFR (eGFR) is less affected by muscle mass, it may underestimate kidney function in patients with obesity. We sought to evaluate the relationship between body composition defined by computed tomography (CT) scans and discordance between creatinine, eGFR and eGFR in adult patients with cancer.
View Article and Find Full Text PDFObjective: To develop and externally validate a prediction model for severe cisplatin associated acute kidney injury (CP-AKI).
Design: Multicenter cohort study.
Setting: Six geographically diverse major academic cancer centers across the US.
The multiple roles of iron in the body have been known for decades, particularly its involvement in iron overload diseases such as hemochromatosis. More recently, compelling evidence has emerged regarding the critical role of non-transferrin bound iron (NTBI), also known as catalytic iron, in the care of critically ill patients in intensive care units (ICUs). These trace amounts of iron constitute a small percentage of the serum iron, yet they are heavily implicated in the exacerbation of diseases, primarily by catalyzing the formation of reactive oxygen species, which promote oxidative stress.
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- Acute kidney injury (AKI) is common in critically ill patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT), with a study revealing that 21% of 529 patients required kidney replacement therapy (AKI-KRT).
- Risk factors for needing AKI-KRT include lower kidney function before transplant, certain complications like veno-occlusive disease, and critical health indicators upon ICU admission.
- A striking 87.4% of patients undergoing AKI-KRT died within 90 days, emphasizing the need for careful evaluation before initiating KRT in these patients.
Key Points: Patients testing positive for platelet factor 4 antibodies have a >50% higher odds of developing severe AKI compared with those who test negative. The relationship between platelet factor 4 antibodies and severe AKI was independent of demographics, comorbidities, laboratory values, and severity-of-illness characteristics.
Background: Heparin-induced thrombocytopenia, which results from production of antibodies that bind to heparin-platelet factor 4 (PF4) complexes, is a hypercoagulable state associated with considerable morbidity and mortality due to thrombotic complications.
Background: Acute kidney injury (AKI) in patients with COVID-19 is partly mediated by thromboinflammation. In noncritically ill patients with COVID-19, therapeutic-dose anticoagulation with heparin increased the probability of survival to hospital discharge with reduced use of cardiovascular or respiratory organ support.
Objectives: We investigated whether therapeutic-dose heparin reduces the incidence of AKI or death in noncritically ill patients hospitalized for COVID-19.
Introduction: Hyperthermic intraoperative cisplatin (HIOC) is associated with acute kidney injury (AKI). Administration of high-dose magnesium attenuates cisplatin-induced AKI (CP-AKI) in animal models but has not been rigorously examined in humans.
Methods: We tested the feasibility and safety of different doses of magnesium in mesothelioma patients receiving HIOC.
Importance: Serum creatinine-based estimated glomerular filtration rate (eGFRcr) may overestimate the glomerular filtration rate (GFR) in patients with cancer. Cystatin C-based eGFR (eGFRcys) is an alternative marker of GFR.
Objective: To determine whether the therapeutic drug levels and adverse events (AEs) associated with renally cleared medications were higher in patients with cancer whose eGFRcys was more than 30% lower than their eGFRcr.
Purpose: To investigate if the timing of initiation of invasive mechanical ventilation (IMV) for critically ill patients with COVID-19 is associated with mortality.
Materials And Methods: The data for this study were derived from a multicenter cohort study of critically ill adults with COVID-19 admitted to ICUs at 68 hospitals across the US from March 1 to July 1, 2020. We examined the association between early (ICU days 1-2) versus late (ICU days 3-7) initiation of IMV and time-to-death.
Article Synopsis
- Overactivation of the renin-angiotensin system (RAS) could lead to worse outcomes for COVID-19 patients, prompting a study to see if ACE inhibitors or ARBs could help.
- In a clinical trial with 721 patients, participants were randomly assigned to receive either an ACE inhibitor, an ARB, or no RAS inhibitor to evaluate their effects on patient recovery.
- Results showed no significant improvement in organ support-free days among the treatment groups compared to the control, leading to the discontinuation of enrollment due to safety concerns.
Article Synopsis
- * The research found that 33.4% of patients experienced AKI within 30 days of transplantation, with certain factors like high levels of rapamycin, specific drug combinations, and lower blood albumin and hemoglobin levels significantly increasing the risk.
- * Additionally, the study evaluated the impact of periengraftment
Background: Clinical trials of immune checkpoint inhibitors (ICIs) often do not include patients with advanced chronic kidney disease (CKD). We aimed to determine the safety of ICIs in patients with cancer and advanced CKD (stages 4-5 CKD, estimated glomerular filtration rate [eGFR] <30 mL/minute/1.73 m2).
View Article and Find Full Text PDFBackground: Creatinine-based estimated glomerular filtration rate (eGFR) may overestimate kidney function in patients with cancer. Cystatin C-based eGFR (eGFR) is an alternative marker of kidney function. We investigated whether patients with an eGFR discrepancy, defined as eGFR >30% lower than the concurrent eGFR, had an increased risk of adverse events resulting from renally-cleared medications.
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