For the regulatory authorities in Europe, however, it is unclear

For the regulatory authorities in Europe, however, it is unclear whether FDCs in general have a positive benefit-risk balance. Hence, more research is needed to show that use of FDCs improves treatment effectiveness through better compliance, adherence and quality of life for patients, which may lead to a positive pharmacoeconomical benefit for society. Evidence-based

data are thus needed, especially Liproxstatin-1 for those patient groups requiring multiple drugsfor example, the elderly. In this context, hospital practice regarding FDCs is crucial, as the recommended pharmacotherapy at discharge of the patient serves as a role model for outpatient care, and therefore needs greater recognition. The benefit-risk balance and pharmacoeconomical consequences of FDCs should also be a subject for attention in the hospital pharmacy setting.”
“Background and objectives Patients with immune-mediated kidney disease and liver failure often require plasma exchange (PE) and hemodialysis (HD). Combining both methods (i.e., connecting the PE and HD circuits in series [tandem dialysis]) should allow for a more efficient treatment. This work reviews the authors’ experience with tandem blood purification. Design, setting, participants, & measurements Chart review was utilized to retrospectively analyze the efficacy and tolerability of 92

combined PE/HD (cPE/HD) sessions in 26 children in comparison with 113 sequential PE/HD (sPE/HD) treatments performed in 32 children between 1988 and 2012 at the University of Heidelberg Center for MMP inhibitor Pediatric and Adolescent Medicine. Eleven children received both treatment modalities. Results The mean treatment duration was 3.8 +/- 2.2 hours per cPE/HD and 5.9 +/- 1.6 hours per sPE/HD session (P smaller than 0.001). Dialyzer surface areas per body Rabusertib order surface area (in meters squared) and blood flow rates were similar. Although a 3-fold higher initial bolus of heparin was administered with cPE/HD, the heparin dose per hour was similar with both modalities and the total heparin load was only slightly lower with cPE/HD, with a median 2939 IU/m(2) per session (interquartile

range, 1868, 4189) versus 3341 IU/m(2) per session (interquartile range, 2126, 4792). In sessions with regional anticoagulation, equal citrate and calcium infusion rates were applied. Plasma turnover, ultrafiltration rates, and solute removal were comparable. Procedure-related problems developed in 14.0% of cPE/HD and 7.0% of sPE/HD sessions (P=0.37). Clinical symptoms occurred in 19.6% and 6.2% (P=0.05), necessitating treatment discontinuation in 12.0% and 5.3% of the sessions (P=0.14). Infra-individual comparison of both dialysis methods in 11 children reconfirmed these findings. Conclusions cPE/HD is a time-saving procedure relative to sPE/HD, but may be associated with a higher rate of procedure-related and clinical adverse events.

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