Previously, the Sapporo Society of Nephrology and Pharmacotherapy (currently known as the Hokkaido Society of Nephrology and Pharmacotherapy) had collected data on the serum calcium and phosphorus levels from 331 patients undergoing hemodialysis at five hospitals in Sapporo. In this study, using these data, we reevaluated the effects of gender and age on the control of these chronic kidney disease (CKD)-related minerals. The mean serum calcium level was 9.1 mg/dL, and 71% of the patients investigated were within the target range advocated in clinical practice guidelines of the Japanese Society for Dialysis Therapy (JSDT). On the other hand, the mean serum phosphorus level was 5.4 mg/dL, and 61% of patients were in the target range set out in the guidelines. When serum phosphorus levels of 331 hemodialysis patients were classified in three groups (high, adequate, and low) according to target range of the JSDT clinical practice guidelines, the number of patients distribution in the high group was approximately 5-fold greater than that in the low group. Moreover, serum phosphorus levels were significantly higher in younger than in older hemodialysis patients. No gender differences were observed either calcium or phosphorus levels. These results suggest that phosphorus control is more problematic than calcium control, and this tendency was more marked in younger patients. As adherence to the intake of phosphate binders is necessary for younger patients, pharmacists should provide them with precise information about their appropriate use. (232 words)
Purpose: To examine the efficacy of the dipeptidyl peptidase-4 (DPP-4) inhibitor teneligliptin in patients with diabetes undergoing hemodialysis.Subjects and Methods: A total of 16 patients with diabetes undergoing maintenance hemodialysis patients (an initial treatment group of receiving a DPP-4 inhibitor [n=9] and a changeover from alogliptin group [n=7]) were treated with teneligliptin (20 mg once a day) for more than 3 months, and the efficacy and safety were determined. Results: In the initial treatment group of receiving a DPP-4 inhibitor (6 patients received teneligliptin alone and 3 received supplementation with mitiglinide), the plasma glucose before hemodialysis (PG) and glycated albumin (GA) levels significantly decreased after the administration of teneligliptin for 3 months (PG decreased from 185±44 mg/dL to 153±28 mg/dL, p<0.05; GA decreased from 23.4±3.8% to 19.7±3.0?, p<0.01). The proportion of patients having good glycemic control of less than 20% of the GA levels significantly increased from 11.1% to 55.6% （p<0.05）after the administration of teneligliptin for 3 months. In the changeover from alogliptin group the PG and GA levels did not change significantly after the administration of teneligliptin for 3 months. No adverse events or hypoglycemia was observed during the observation period.Conclusion: Teneligliptin is an effective and safe drug for hemodialysis patients. The hypoglycemic effect of 20 mg of teneligliptin is approximately equivalent to that of 6.25 mg of alogliptin.
A conventional nomogram, based on creatinine clearance (CCR), was developed to provide an individualized, optimized, dosage regimen for the carbapenem antibacterial agents, meropenem (MEPM) and doripenem (DRPM), in elderly patients. The nomogram was developed using the Monte Carlo simulation method, to achieve an 80% probability of maintaining plasma drug levels above the minimum inhibitory concentration (MIC) for over 40% of the time (40% TAM), based on pharmacokinetic–pharmacodynamic (PK–PD) parameters obtained from population parameters of Japanese adult patients. Data on 35 patients (MEPM) and 29 patients (DRPM) treated according to a dosage regimen determined using the nomogram were then compared with data on 33 patients (MEPM) and 26 patients (DRPM), respectively, treated without using the nomogram. The intervention effect was evaluated retrospectively by comparing the rate of achievement of 40% TAM, daily dose, administration interval, length of administration period, clinical response and adverse events (AEs) of the two groups for the two corresponding drugs. After the introduction of the nomogram (the intervention), the achievement of 40% TAM was significantly increased for both drugs: MEPM from 75.8% to 94.3% (p=0.03), DRPM from 61.5% to 90.7% (p=0.01). The total daily dose was also significantly increased: MEPM from 0.92±0.28 g to 1.10±0.40 g (p=0.04); DRPM from 0.46±0.17 g to 0.53±0.09 g (p=0.01). The number of patients receiving once a day administration was dramatically reduced using the normogram compared with before the intervention: MEPM from n=9 to n=3 (p=0.04), DRPM from n=8 to 0 (p<0.01), and the length of antibiotic therapy was significantly decreased: MEPM from 10.0±3.7 days to 8.5±3.8 days (p=0.04), DRPM from 10.7±3.7 days to 8.4±3.2 days (p=0.03). The time taken for body temperature to be maintained below 37.0℃ for more than 24 h was shorter following the intervention than it had been before the intervention (MEPM 3.9±1.7 days from 4.5±1.6 days, p=0.04; DRPM 4.1±1.6 days from 4.8±1.7 days, p=0.04). The clinical failure rate for DRPM was significantly lower after the intervention (from 7 to 2, p=0.04), while for MEPM the difference was insignificant (from 5 to 3). No severe AEs were observed. Overall, the use of the proposed nomogram, which uses renal function data to calculate the optimized dosage regimen for carbapenems for individual elderly patients, seems to offer promising treatment-enhancing prospects.
Hyperphosphatemia is associated with vascular calcification and prognosis. Therefore, controlling serum phosphate concentrations at the early predialysis chronic kidney disease (CKD) stages is important. Precipitated calcium carbonate is mainly used to control serum phosphate concentrations of individuals with CKD, especially in Japan; however, it interacts with gastric secretion inhibitors and may affect vascular calcification. Necessarily, this has to be considered before prescribing, but is not pervading clinically. In this study, pharmacists in our hospital provided information about the drug-drug interaction and its vascular risk to physicians treating individuals with predialysis CKD meeting the following criteria in January 2014: 1) serum phosphate concentration >4.5 mg/dL, 2) using precipitated calcium carbonate and a gastric secretion inhibitor. Seven individuals met these criteria, which the pharmacists reported to the attending physicians; all prescription pattern changes were recorded. The prescription of 5 out of 7 individuals was changed; the precipitated calcium carbonate and/or gastric secretion inhibitor was discontinued. Providing this information also decreased the combination prescription rate in the entire hospital from 75% to 21%. We also surveyed physicians on the clinical benefits of information provision by pharmacists. Four out of 6 physicians answered that they were not aware of this specific drug-drug interaction. All physicians answered that the information provided affected the prescription policy for individuals with predialysis CKD.Our results indicate that pharmacists’ recommendations affect prescription patterns, and that physician-pharmacist collaborations may contribute to improving the efficacy and safety of pharmacotherapy in various therapeutic areas.