To determine the efficacy and tolerability of azilsartan 40 mg after switching from other renin-angiotensin system (RAS) inhibitors, we examined the number of antihypertensive drugs taken and blood pressure before hemodialysis (HD) and over 48 hours by ambulatory blood pressure monitoring (ABPM). Subjects were 9 HD patients who were receiving 5 antihypertensive drugs. Clinical data were collected from August 2012 to February 2013. The type and number of antihypertensive drugs were significantly decreased from 6.0±0.9 and 15.4±4.5 at baseline to 4.0±1.7 and 10.0±6.3 at the end of study (p<0.05), respectively. Blood pressure before HD showed no statistical difference at baseline versus end of study (136.9±20.8 mmHg versus 136.7±16.9 mmHg, p=0.90). Of 8 patients who underwent 48 hour ABPM, 3 showed improvement in the night - day blood pressure ratio while 5 showed no change, and none experienced deterioration. Day systolic blood pressure tendency decreased from 136.5±5.3 mmHg to 134.5±8.4 mmHg after administration of azilsartan. However, night systolic blood pressure significantly decreased from 138.5±4.0 mmHg to 132.8±6.6 mmHg after administration of azilsartan. Our study demonstrated that the type and number of antihypertensive drugs were significantly decreased and the night - day blood pressure ratio was improved after the switch to azilsartan.
Due to the increased skin penetration and good local anesthetic effects of EMLA cream, it is used as a local anesthetic to reduce the pain caused by venipuncture in hemodialysis patients. The active ingredients of EMLA cream, lidocaine and propitocaine, are transferred to the blood after the application of the cream under an occlusive dressing for 1 hour. Information about drug elimination during hemodialysis is important. However, there is no information about the hemodialysis efficiency of lidocaine and propitocaine during hemodialysis performed using high-performance dialysis membranes. Therefore, the clearance of lidocaine and propitocaine during hemodialysis were evaluated using miniaturized in vitro dialysis systems. Twenty-ml samples of human plasma containing lidocaine and propitocaine were dialyzed for 240 min using the miniaturized dialyzers (effective surface area, 26.4 cm2 plasma flow, 2mL/min;dialysate flow, 5mL/min), which were composed of hollow fiber dialysis membranes that had been removed from a commercially available hemodialyzer, and the lidocaine and propitocaine concentrations of the plasma samples were measured. The plasma concentrations of lidocaine and propitocaine gradually decreased due to dialysis. The clearance values of lidocaine and propitocaine during hemodialysis conducted in clinical conditions (effective surface area, 1.5 m2 blood flow, 200mL/min;dialysate flow, 500mL/min;hematocrit;44%) were predicted to be 34.2 and 64.1 mL/min, respectively. The predicted clinical hemodialysis clearance values were lower than the total body clearance values (lidocaine, 950 mL/min; propitocaine, 1910 to 2570 mL/min).
The Shizuoka Kidney and Pharmaceuticals Study Group performed a questionnaire survey about the intervention of pharmacists in nephrology and pharmacotherapy during its first annual meeting.The questionnaire consisted of 20 multiple-choice questions about the frequency of estimating renal function, frequency of inquiries about prescriptions, and necessity of recording laboratory data in the prescription or drug profile book.Sixty-two pharmacists (42 hospital pharmacists and 20 community pharmacists) answered the questionnaire. Fifty-three pharmacists (85%) answered that they confirmed laboratory data of renal function when they check prescriptions. Forty pharmacists (65%) used estimated glomerular filtration rate (eGFR) to evaluate renal function to check the dosage of medication, and 17 out of those 40 pharmacists (43%) used eGFR uncorrected for body surface area.While 37 out of 42 hospital pharmacists (88%) inquired about prescriptions based on evaluation of renal function, only 11 out of 20 (55%) community pharmacists did the same. The most frequent inquiries were about “over-dosage” (94%), whereas those concerning “drug-drug interactions” were the least frequent (15%). The pharmacists used different methods to obtain patient’s laboratory data. Most hospital pharmacists (n = 38, 90%) relied on medical records, while community pharmacists (n = 18, 90%) tended to obtain them directly from patients.While 17 community pharmacists (85%) hoped for recording of laboratory data in the prescription, 35 hospital pharmacists (83%) did not record them in prescriptions. Similarly, while 13 community pharmacists (65%) hoped for recording of laboratory data in the drug profile book, almost all hospital pharmacists (n = 38, 90%) did not record them in the drug profile book.To improve chronic kidney disease management, it is necessary to conduct workshops on nephrology and pharmacotherapy. Forming a working relationship between hospitals and community pharmacies and sharing patient information will help community pharmacists obtain hospital laboratory data.