The American Society of Nephrology's (ASN) Quality and Patient Safety Task Force asked the ASN's 10 Advisory Groups to submit recommendations on safe clinical practice. One of these relates to anemia. The other recommendations from the ASN also make sense, but I am most interested (unsurprisingly) in the anemia one:
"Do not administer erythropoiesis stimulating agents — drugs that are commonly used to treat anemia — to chronic kidney disease (CKD) patients with hemoglobin levels ≥10 g/dL without symptoms of anemia."
The point is that you should consider ESA treatment to correct anemia in CKD patients as a non-disease modifying therapy. The data shows that correction of anemia with ESAs doesn't reduce progression of renal disease, doesn't reduce cardiovascular events, and doesn't reduce mortality.
For each patient, individualize therapy - weighing risks and benefits. Establish the hemoglobin trigger - the Hb level at which the patient needs an intervention. In some patients symptomatic at 10.5 g/dL treatment needs to be initiated - either an ESA or iron therapy depending on what the problem is.
In a previous post (November 2011) the idea of a Hb trigger was discussed. I suggest that that you develop individualized Hb triggers for each patient in your practice - it's not that hard to do.
"Do not administer erythropoiesis stimulating agents — drugs that are commonly used to treat anemia — to chronic kidney disease (CKD) patients with hemoglobin levels ≥10 g/dL without symptoms of anemia."
The point is that you should consider ESA treatment to correct anemia in CKD patients as a non-disease modifying therapy. The data shows that correction of anemia with ESAs doesn't reduce progression of renal disease, doesn't reduce cardiovascular events, and doesn't reduce mortality.
For each patient, individualize therapy - weighing risks and benefits. Establish the hemoglobin trigger - the Hb level at which the patient needs an intervention. In some patients symptomatic at 10.5 g/dL treatment needs to be initiated - either an ESA or iron therapy depending on what the problem is.
In a previous post (November 2011) the idea of a Hb trigger was discussed. I suggest that that you develop individualized Hb triggers for each patient in your practice - it's not that hard to do.
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JBC: confirmed two kinds of anti-cancer drugs that inhibit influenza virus infection
ReplyDeleteUniversity of Helsinki, Finland, from the Finnish Institute for Molecular Medicine, a medical systems virology team collaboration with other partners to develop a new cell-based screening method, and this method can be used to identify influenza antiviral drugs. Researchers have identified two new anti-influenza virus activity of the compound obatoclax and gemcitabine (gemcitabine), a previously known and confirmed the efficacy of drugs saliphenylhalamide. This study has been published in the Journal of Biological Chemistry journals.
Influenza virus to cause significant morbidity and mortality people. For the treatment of these viral infections, various targeting viral drugs have been developed. However, currently available drugs are targeting viral proteins, but because influenza viruses mutate rapidly develop resistance to them. For this reason, should be targeted next host antiviral function. The results of this study lay the foundation for developing the next generation of antiviral drugs. Furthermore, these drugs have been identified chemical tools can be used to enable the study of virus - host interactions molecular mechanism.
Corresponding author Denis Kainov papers, says the study's interesting is that the drug obatoclax, saliphenylhalamide and gemcitabine even mediated cell death in higher than lower concentrations needed, they can exhibit anti-viral effect. However, these drugs can be used in clinical testing and influenza virus infection before, further research is needed.
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