Drug Transporter Function--Implications in CKD.

Drug transporters typically move substrates, including drugs, in an intracellular to extracellular direction and thus are efflux transporters. There is a small subset of transporters that move substrates in the opposite direction and are classified as influx transporters. Collectively, drug transporters contribute to the pharmacokinetic profile of a wide variety of drugs and other molecules including xenobiotics, metabolites, and endogenous solutes.

Aldosterone blockade in CKD: emphasis on pharmacology.

Besides its epithelial effect on sodium retention and potassium excretion in the distal tubule, aldosterone promotes inflammation and fibrosis in the heart, kidneys, and blood vessels. As glomerular filtration rate falls, aldosterone is inappropriately elevated relative to extracellular fluid expansion. In addition, studies in CKD patients on angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and/or direct renin inhibitors have shown that aldosterone levels paradoxically rise in approximately 30% to 40% of patients on these renin-angiotensin system-blocking drugs.

Should mycophenolate mofetil replace cyclophosphamide as first-line therapy for severe lupus nephritis?

Available treatments for severe (class III, IV, and V) lupus nephritis (LN) have expanded greatly over the last 40 years. In the 1970s and 1980s, cyclophosphamide (CYC), in combination with glucocorticoids, gained favor as induction and maintenance therapy for severe LN. However, the adverse event profile of CYC led to the search for other medications for severe LN.

Ferumoxytol: a new intravenous iron preparation for the treatment of iron deficiency anemia in patients with chronic kidney disease.

Ferumoxytol is an intravenous iron preparation for treatment of the anemia of chronic kidney disease (CKD). It is a carbohydrate-coated, superparamagnetic iron oxide nanoparticle. Because little free iron is present in the preparation, doses of 510 mg have been administered safely in as little as 17 seconds.

The safety and efficacy of ferumoxytol therapy in anemic chronic kidney disease patients.

Background: Administration of safe and effective iron therapy in patients with chronic kidney disease is a time consuming process. This phase II clinical trial studied ferumoxytol, a semi-synthetic carbohydrate-coated iron oxide administered by rapid intravenous injection to anemic chronic kidney disease patients (predialysis or undergoing peritoneal dialysis).

Methods: Inclusion criteria included hemoglobin < or =12.

Safety of iron sucrose in hemodialysis patients intolerant to other parenteral iron products.

Background/aims: This report summarizes the data gathered in four prospective studies of intravenous iron sucrose therapy administered to iron-deficient hemodialysis patients with a history of intolerance to other parenteral iron preparations.

Methods: A total of 130 iron dextran- and/or sodium ferric gluconate-sensitive patients received intravenous iron sucrose therapy to correct iron deficiency, and/or maintain body iron stores. A history of intolerance to iron dextran alone was reported in 109 patients, to ferric sodium gluconate alone in 6 patients, and to both iron dextran and ferric sodium gluconate in 15 patients.

The safety and efficacy of an accelerated iron sucrose dosing regimen in patients with chronic kidney disease.

Background: Provision of adequate iron to support erythropoiesis in patients with chronic kidney disease (CKD) is time consuming and may present adherence problems for patients in the outpatient setting. We studied an accelerated regimen of high-dose intravenous iron sucrose therapy in a cohort of iron-deficient, anemic CKD patients.

Methods: Intravenous iron sucrose 500 mg was infused over three hours on two consecutive days in 107 CKD patients (glomerular filtration rate, 32.

Prediction of single-pool Kt/v based on clinical and hemodialysis variables using multilinear regression, tree-based modeling, and artificial neural networks.

The impact of clinical and other variables on single-pool Kt/V (spKt/V) is unclear. The goal of this study was to identify clinical and hemodialysis treatment related predictors of spKt/V and use multilinear regression (LM), tree-based modeling (TBM), and artificial neural networks (ANN) to predict actual spKt/V. When 602 hemodialysis records were analyzed, spKt/V correlated with urea reduction ratio (URR) (r=0.

New empiric expressions to calculate single pool Kt/V and equilibriated Kt/V.

Most formulae used for Kt/V computations are cumbersome and require variables that are not always available. Even the simplest models involve urea distribution volume or patient postdialysis weight. Calculating urea reduction ratio (URR) is easier and does not require additional variables, but it fails to account for residual renal function or for the removal of urea when urea levels do not change, e.