Nutritional education programmes can achieve excellent results when appropriately applied. An education programme may be effective across different literacy levels.
Hydraulic Resistance is highly prevalent among long-term central venous catheters. Heparin catheter lock solutions are commonly used to maintain catheter patency, however this problem remains high. The purpose of the CLOCK Trial was to evaluate two catheter lock solutions as to their effectiveness and safety. Seventy-five CKD 5D patients on high-efficiency hemodialysis at the Integrated Centre of Nephrology (Guarulhos, Brazil) were randomized 1:1:1 to receive a lock solution combining minocycline 3 mg/ml with the anticoagulant/chelation agent EDTA 30 mg/ml (M-EDTA) or heparin 1,000 IU/ml (Heparin) or trisodium citrate 30% (Citrate) versus Heparin for 15 weeks. A total of 68 patients completed the trial in which both investigators and patients were blinded to treatment allocation. The primary end-point was the occurrence of hydraulic resistance and secondary safety end-point was adverse drug reactions related to the lock solutions. The incidence of hydraulic resistance was significantly higher among patients on Heparin (18/23) compared to Citrate (4/22) and M-EDTA (2/23) lock solutions, (p< 0.001). The trial suggests Citrate and M-EDTA may preserve catheter patency better than Heparin and they may show higher cost-effectiveness when compared to heparin. Citrate may be a better option due the lack of association with longterm antimicrobial resistance.
JOÃO-LUIZ, M. V. S. Vancomycin and renal failure: use-related problems in patients under hemodialysis. 2011. 115 p. Masters thesis (Pharmacology) -Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, 2011. Vancomycin (VANCO), a glycopeptides antimivrobial, has been considered the first therapeutic option for treatment of MRSA infections. Nowadays, in order to achieve efficacy and safety, it is recommended VANCO therapeutic plasma concentrations range between 15 and 20 g/mL. Retrospective cross-sectional study (December 2008 to December 2009), of 15 patients (9 with acute kidney injury; 2 with acute non dialytic kidney disease and 4 with dialytic kidney disease, stage 5), charged at surgery and medical clinics. All patients were dialytic and received several doses of 1g of VANCO. Serum VANCO levels were analysed using Fluorescence Polarization Immunoassay The administration frequencies were got for each patient and compared to VANCO plasma concentrations in order to identify the possible Drug-related-Problems (DRP). The correlation between VANCO plasma levels and treatment period and missed doses period was got, using Spearman Correlation coefficient. The most VANCO serum levels were out of the therapeuic range. Forty serum levels (43%) were below 15 µg/mL while twenty four (25.8%) were above 20µg/mL. Thirteen patients have experienced missed dose periods. This sutdy allows us tosuggest that VANCO doses must be prescribed according to the patient Actual Body Weight (ABW), considering results of trough plasma concentrations obtained before hemodialysis session. Our results suggest that through plasma levels are obtained every 48 hours in patients with creatinine clearance below 20 mL/min. These suggestions have been incorporated to the VANCO use protocolo of the São Paulo University Hospital Infection Control Committee.
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