1.
Preservation of residual renal function by not removing water in new hemodialysis patients: a randomized, controlled study.
Liu, S, Diao, Z, Zhang, D, Ding, J, Cui, W, Liu, W
International urology and nephrology. 2014;(1):83-90
Abstract
PURPOSE To investigate the effect of no water removal (NWR) on preservation of residual renal function (RRF) in new hemodialysis (HD) patients. METHODS Fifty-six patients with a daily urine volume ≥ 1,000 mL were included. Patients were randomized to different fluid management groups of NWR or water removal (WR) for 6 months. If predialysis BP was >150/90 mmHg, patients could take antihypertensive drugs. The primary endpoints included death, cardio-cerebral vascular disease, refractory hypertension, and edema or an auxiliary examination indicating obvious fluid retention. The secondary endpoint was oliguria. A daily urine volume, 24-h urine creatinine clearance, the defined daily dose (DDD) index of antihypertensive drugs, erythropoietin resistance index, cardiothoracic ratio, and left ventricular mass index (LVMI) were recorded. RESULTS Eight patients in the NWR group reached the primary endpoints. Nine patients in the WR group reached the secondary endpoint. At the end of the study, patients in the NWR group had more increased systemic blood pressure (9.0 ± 8.3 vs. -2.4 ± 2.0 mmHg, p < 0.001), DDD index (1.2 ± 1.02 vs. -0.9 ± 0.51, p < 0.001), daily urine volume (164 ± 351 vs. -726 ± 342 mL, p < 0.001), cardiothoracic ratio (0.02 ± 0.04 vs. -0.03 ± 0.03, p < 0.001), LVMI (9.6 ± 17.0 vs. -12.0 ± 21.4 g/m(2), p < 0.001), and less decreased urine creatinine clearance (-1.0 ± 0.4 vs. -2.0 ± 1.0, p < 0.001), compared with those patients in the WR group. CONCLUSIONS Preservation of RRF by NWR is warranted in new HD patients, but is not appropriate for all patients.
2.
Probenecid, but not cystic fibrosis, alters the total and renal clearance of fexofenadine.
Liu, S, Beringer, PM, Hidayat, L, Rao, AP, Louie, S, Burckart, GJ, Shapiro, B
Journal of clinical pharmacology. 2008;(8):957-65
Abstract
This study aims to evaluate renal P-glycoprotein (P-gp) activity in patients with cystic fibrosis. P-gp efflux activity in peripheral T cells was measured by flow cytometry in 10 cystic fibrosis and 15 healthy volunteers. Eight cystic fibrosis patients and 8 healthy volunteers were recruited into a crossover pharmacokinetic study in which participants received 180 mg fexofenadine with or without 1 g probenecid twice a day. Genotyping was performed for ABCB1 C1236T, G2677T, and C3435T. P-gp efflux activity in peripheral T cells was not significantly different between cystic fibrosis patients and healthy volunteers. No difference in fexofenadine pharmacokinetic parameters was observed between cystic fibrosis patients and healthy volunteers when fexofenadine was administered with or without probenecid. Coadministration of probenecid significantly increased fexofenadine AUC and decreased the cumulative urinary excretion, total body clearance, and renal clearance. ABCB1 3435 C/T carriers showed increased basal P-gp activity in CD4+ and CD8+ T cells, increased R123-induced efflux activity in CD4+ T cell, and decreased fexofenadine AUC. Fexofenadine disposition and P-gp efflux activity in peripheral T cells was similar between cystic fibrosis patients and healthy volunteers. Probenecid administration significantly reduced the total body and renal clearance of fexofenadine. ABCB1 3435 C/T was associated with an elevated efflux activity compared with C/C subjects.