Drugs

Can pharmacologic interventions be used in patients on dialysis to improve nutritional status? Pharmacologic measures to improve nutrition include appetite stimulators (megestrol acetate) or interventions to improve biochemical measures of PEW, such as the use of anabolic hormones. These interventions have been tested in small clinical trials, but their use in clinical practice remains uncommon, …

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What are hypoxia inducible factor prolyl hydroxylase inhibitors? Several agents are under development that potentiate the activity of HIF, the substance in the kidney and other tissues that senses decreased delivery of oxygen (from hypoxemia or anemia) and stimulates the production of EPO. In the absence of hypoxia, HIF is rapidly degraded by an enzyme, …

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What are biosimilars? Since Erythropoiesis Stimulating Agents are complex proteins with side chains, not every molecule is identical to each other, and therefore it is impossible to develop a “generic” version that is identical to the originator molecule. For biologic drugs whose patents have expired, the FDA has developed an approval pathway for biosimilar agents …

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What is the recommended dose of darbepoietin? Darbepoetin alfa is an analog of human EPO, with two extra carbohydrate side chains and a longer duration of action when compared with both native and recombinant hormone. The recommended starting dose for darbepoetin alfa is 0.45 mcg/kg administered weekly or 0.75 mcg/kg administered biweekly in dialysis and …

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What is the recommended dose of epoetin? For patients receiving epoetin IV on HD, the recommended starting dose is 50 units/kg of body weight three times weekly. For patients receiving epoetin therapy subcutaneously, the recommended starting dose is 30 units/kg administered three times weekly (as is typically done in HD facilities) or 100 units/kg/week administered …

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What drugs must be avoided in Chronic kidney disease? Whenever possible, nephrotoxic medications should be avoided including NSAIDs, which should be stopped when eGFR is <30 mL/min per 1.73m 2 and not prescribed long-term in patients with eGFR <60 mL/min per 1.73m 2 . Other nephrotoxic medications are aminoglycosides, amphotericin, and cisplatin. The GFR level needs to be considered …

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Side effects of medications on Kidneys • Hypertension and proteinuria are the most common adverse effects on the kidneys of the antiangiogenesis inhibitors (bevacizumab, sorafenib, sunitinib), which target the vascular endothelial growth factor signaling pathway. • The proton pump inhibitors are associated primarily with acute interstitial nephritis (AIN); however, less common adverse effects involving the kidneys include …

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