renal function
Predictors of "Worsening Renal Function" In Patients Hospitalized In Internal Medicine Department
Sun, 2011-03-13 15:57 — Samah W. Al-Jabi
AIM: The aim of this study was to identify predictors of worsening renal function (WRF) among hospitalized patients in the internal medicine department.
SETTINGS AND DESIGN: A one-year, hospital-based prospective study.
METHODS AND MATERIAL: This study was carried out at the internal medicine department of Al-Watani governmental hospital, Palestine. Inclusion criteria were: hospitalization for at least 48 hours and availability of at least three serum creatinine (Scr) measurements. WRF was defined, per hospital stay, as an elevation in Scr of > or = 0.5 mg/dL from baseline value if baseline Scr value was < 3 mg/ dL and 1 mg/dL if the baseline value was > or = 3 mg/dL. Baseline measurements were made at hospital admission.
STATISTICAl ANALYSIS: Regression analysis (enter method) was carried out on two sets of variables: non-medication variables (Model I) and medication variables (Model II). Statistics was performed using SPSS version 15. RESULTS: Three hundred and sixty one patients were included in this study. The prevalence of WRF among those who met the inclusion criteria was 40.2%. In the majority of cases, WRF started within the first 48 hrs of admission. Analysis of data indicated that eight variables were significantly associated with WRF: renal dysfunction (P< 0.0001), diabetes mellitus (P= 0.005), hypertension (HTN) (P< 0.0001), congestive heart failure (CHF) (P= 0.021), elderly (being > 65 years) (P= 0.003), number of diagnosis (P< 0.001), furosemide (P = 0.001) and calcium channel blockers (P= 0.01) administration at admission. Regression analysis indicated that HTN (P =0.033) and renal dysfunction (P= 0.007) were predictors of WRF in model I, while furosemide administration (P= 0.01) was the only predictor of WRF in model II.
CONCLUSION: Hypertension, renal dysfunction and furosemide administration at hospital admission are predictors of WRF among hospitalized patients. Clinical characteristics available at hospital admission can be used to identify patients at increased risk for WRF. Patients receiving certain medications, especially loop diuretics, require close observation for potential development of WRF.
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A Prospective Comparative Study of Gentamicin- and Amikacin-Induced Nephrotoxicity in Patients with Normal Baseline Renal Function
Sun, 2010-04-11 17:05 — Professor Waleed M. SweilehThe aim of this study was to compare the nephrotoxic potential of amikacin (AK) and gentamicin (GM) in patients with normal baseline renal function. This study was a 1-year, non-interventional prospective study of patients administered either GM or AK. The study was carried out at the internal medicine department of Al-Watani governmental study. Nephrotoxicity was defined as a serum creatinine (SCr) increase of >or=0.5 mg/dL from the basal (normal) SCr level. The two groups (GM, n = 45 and AK, n = 49) were similar in population composition, and underlying pathological and infectious processes requiring antimicrobials. No significant difference in age was found between patients in the GM and AK groups, P = 0.83. Patients in the GM group received comparatively lower doses than those in the AK group (mean = 2.5 mg/kg/day and 14.4 mg/kg/day, respectively) but the duration of treatment was similar. Sixteen of 45 patients receiving GM (35.6%) and eight of 49 patients receiving AK (16.3%) developed nephrotoxicity, P = 0.033. Single daily dosing with GM, regardless of the total daily dose, produced less nephrotoxicity than multiple dosing. In contrast, AK given at a total dose of 1 g daily, showed no benefit of single dosing compared with multiple dosing. In patients with initial normal renal function, GM was significantly more nephrotoxic than AK. Multiple dosing of GM was more nephrotoxic than single dosing. AK-induced nephrotoxicity was not significantly dependent on dosing frequency.
