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Article ; Online: Kidney Function Assessment in African American Patients: A Narrative Review for Pharmacists.

Rungkitwattanakul, Dhakrit / Chaijamorn, Weerachai / Han, Eunice / Aldhaeefi, Mohammed

2022 Volume 10, Issue 3

Abstract: Recent recognitions of longstanding societal inequity in kidney function assessments have prompted the call to eliminate race as part of the algorithm to assess estimated glomerular filtration rate (eGFR). Previous equations for eGFR estimation adopted ... ...

Abstract	Recent recognitions of longstanding societal inequity in kidney function assessments have prompted the call to eliminate race as part of the algorithm to assess estimated glomerular filtration rate (eGFR). Previous equations for eGFR estimation adopted race as part of the calculation. Incorporating race within eGFR equations results in overestimating and underestimating Black and nonblack patients, respectively. The inclusion of race is controversial. In September 2021, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) combined task force recommended estimating the kidney function without using a race variable. The task force endorsed race-free creatinine-cystatin C equations to be more accurate than the creatinine-only equations. Before the application of NKF-ASN revised recommendations, major healthcare disparities influenced daily clinical practice. Those disparities include the delay in initiating medications that have reanl or cardio-protective effects, such as sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and angiotensin-converting enzyme inhibitors (ACEIs). Clinical judgment should be employed when dose adjusting medications. Combining the eGFR with other clinical assessment tools such as urinary output, the expanded use of confirmatory tests, and the eGFR trend is suggested for a better kidney function assessment. Additionally, creatinine-cystatin C is recommended when feasible, and when institutions have the laboratory abilities.
Language	English
Publishing date	2022-06-20
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2737194-3
ISSN	2226-4787 ; 2226-4787
ISSN (online)	2226-4787
ISSN	2226-4787
DOI	10.3390/pharmacy10030065
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Article ; Online: Pharmacokinetics of intravenous piperacillin/tazobactam among patients with peritoneal dialysis-associated peritonitis.

Maneerot, Taweesak / Wongpraphairot, Suwikran / Lucksiri, Aroonrut / Jaruratanasirikul, Sutep / Chaijamorn, Weerachai / Ninwisut, Nanthawut / Parinyasiri, Uraiwan / Suteeka, Yuttitham / Pattharachayakul, Sutthiporn

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis

2024 , Page(s) 8968608241241449

Abstract: Currently, pharmacokinetic information on intravenous (IV) piperacillin/tazobactam in patients with peritoneal dialysis-associated peritonitis (PD peritonitis) is limited. This study employed a prospective single-dose pharmacokinetic design to assess the ...

Abstract	Currently, pharmacokinetic information on intravenous (IV) piperacillin/tazobactam in patients with peritoneal dialysis-associated peritonitis (PD peritonitis) is limited. This study employed a prospective single-dose pharmacokinetic design to assess the pharmacokinetics of IV piperacillin/tazobactam in these patients. Four patients with PD peritonitis who received an IV loading dose of 4000 mg/500 mg piperacillin/tazobactam were enrolled in this study. The concentrations of piperacillin and tazobactam in plasma, peritoneal dialysis fluid (PDF) and urine were determined by high-performance liquid chromatography. Non-compartmental methods were used for pharmacokinetic analysis. During a 6-h dwell time for chronic ambulatory peritoneal dialysis (CAPD), 9.23 ± 4.01% of the piperacillin was recovered in the PDF. This result is greater than that observed in patients without peritonitis in prior research. Piperacillin's PD clearance (CL
Language	English
Publishing date	2024-04-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	645010-6
ISSN	1718-4304 ; 0896-8608
ISSN (online)	1718-4304
ISSN	0896-8608
DOI	10.1177/08968608241241449
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Article: Recommendations of Gentamicin Dose Based on Different Pharmacokinetic/Pharmacodynamic Targets for Intensive Care Adult Patients: A Redefining Approach.

Abbasi, Mohammad Yaseen / Chaijamorn, Weerachai / Wiwattanawongsa, Kamonthip / Charoensareerat, Taniya / Doungngern, Thitima

Clinical pharmacology : advances and applications

2023 Volume 15, Page(s) 67–76

Abstract: Background: In addition to the maximum plasma concentration (C: Purpose: This study aimed to predict the optimal effective dose and risk of nephrotoxicity for gentamicin in critically ill patients for two different PK/PD targets within the first 3 ... ...

Abstract	Background: In addition to the maximum plasma concentration (C Purpose: This study aimed to predict the optimal effective dose and risk of nephrotoxicity for gentamicin in critically ill patients for two different PK/PD targets within the first 3 days of infection. Methods: The gathered pharmacokinetic and demographic data in critically ill patients from 21 previously published studies were used to build a one-compartment pharmacokinetic model. The Monte Carlo Simulation (MCS) method was conducted with the use of gentamicin once-daily dosing ranging from 5-10 mg/kg. The percentage target attainment (PTA) for efficacy, C Results: Gentamicin 7 mg/kg/day could achieve both efficacy targets for more than 90% when the MIC was <0.5 mg/L. When the MIC increased to 1 mg/L, gentamicin 8 mg/kg/day could reach the PK/PD and safety targets. However, for pathogens with MIC ≥2 mg/L, no studied gentamicin doses were sufficient to reach the efficacy target. The risk of nephrotoxicity using AUC Conclusion: Considering both targets of Cmax/MIC ~8-10 and AUC
Language	English
Publishing date	2023-07-04
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2520726-X
ISSN	1179-1438
ISSN	1179-1438
DOI	10.2147/CPAA.S417298
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Article: What is the right gentamicin dose for multiple trauma patients? A Monte Carlo simulation exploration study.

Abbasi, Mohammad Yaseen / Wiwattanawongsa, Kamonthip / Chaijamorn, Weerachai / Charoensareerat, Taniya / Doungngern, Thitima

International journal of critical illness and injury science

2023 Volume 13, Issue 3, Page(s) 118–124

Abstract: Background: The appropriate dose of gentamicin is important to prevent and treat infections. The study aimed to determine the optimal dose of gentamicin to achieve the probability of pharmacokinetic/pharmacodynamic (PK) targets for efficacy and safety ... ...

Abstract	Background: The appropriate dose of gentamicin is important to prevent and treat infections. The study aimed to determine the optimal dose of gentamicin to achieve the probability of pharmacokinetic/pharmacodynamic (PK) targets for efficacy and safety in multiple trauma patients. Methods: PK parameters of gentamicin in multiple trauma patients were gathered to develop a one-compartment PK model for prediction. The Monte Carlo simulation method was performed. The 24-h area under the concentration time curve to the minimum inhibitory concentration ratio (AUC24h/MIC) ≥50 was defined for the infection prevention target. AUC24h/MIC ≥110 or the maximum serum concentration to MIC ratio ≥8-10 was for the treatment of serious Gram-negative infection target. The risk of nephrotoxicity was the minimum serum concentration ≥2 mg/L. The optimal dose of gentamicin was determined when the efficacy target was >90% and the risk of nephrotoxicity was lowest. Results: The optimal gentamicin dose to prevent infection when the MIC was <1 mg/L was 6-7 mg/kg/day. A higher dose of gentamicin up to 10 mg/kg/day could not reach the target for treating serious Gram-negative infection when the expected MIC was ≥1 mg/L. The probability of nephrotoxicity was minimal at 0.2-4% with gentamicin doses of 5-10 mg/kg/day for 3 days. Conclusions: Once daily gentamicin doses of 6-7 mg/kg are recommended to prevent infections in patients with multiple trauma. Gentamicin monotherapy could not be recommended for serious infections. Further clinical studies are required to confirm our results.
Language	English
Publishing date	2023-09-21
Publishing country	India
Document type	Journal Article
ZDB-ID	2638865-0
ISSN	2231-5004 ; 2229-5151
ISSN (online)	2231-5004
ISSN	2229-5151
DOI	10.4103/ijciis.ijciis_14_23
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Article: Lacosamide dosing in patients receiving continuous renal replacement therapy.

Chaijamorn, Weerachai / Phunpon, Sathian / Sathienluckana, Thanompong / Charoensareerat, Taniya / Pattharachayakul, Sutthiporn / Rungkitwattanakul, Dhakrit / Srisawat, Nattachai

Journal of intensive care

2023 Volume 11, Issue 1, Page(s) 50

Abstract: Background: Lacosamide is one of the anticonvulsants used in critically ill patients. This study aimed to suggest appropriate lacosamide dosing regimens in critically ill patients receiving continuous renal replacement therapy (CRRT) via Monte Carlo ... ...

Abstract	Background: Lacosamide is one of the anticonvulsants used in critically ill patients. This study aimed to suggest appropriate lacosamide dosing regimens in critically ill patients receiving continuous renal replacement therapy (CRRT) via Monte Carlo simulations. Methods: Mathematical models were created using published demographic and pharmacokinetics in adult critically ill patients. CRRT modalities with different effluent rates were added into the models. Lacosamide regimens were evaluated on the probability of target attainment (PTA) using pharmacodynamic targets of trough concentrations and area under the curve within a range of 5-10 mg/L and 80.25-143 and 143-231 mgh/L for the initial 72 h-therapy, respectively. Optimal regimens were defined from regimens that yielded the highest PTA. Each dosing regimen was tested in a group of different 10,000 virtual patients. Results:* Our results revealed the optimal lacosamide dosing regimen of 300-450 mg/day is recommended for adult patients receiving both CRRT modalities with 20-25 effluent rates. The dose of 600 mg/day was suggested in higher effluent rate of 35 mL/kg/h. Moreover, a patient with body weight > 100 kg was less likely to attain the targets. Conclusions: Volume of distribution, total clearance, CRRT clearance and body weight were significantly contributed to lacosamide dosing. Clinical validation of the finding is strongly indicated.
Language	English
Publishing date	2023-11-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2739853-5
ISSN	2052-0492
ISSN	2052-0492
DOI	10.1186/s40560-023-00700-4
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Article ; Online: Monkeypox 2022: What clinicians in the dialysis community should do.

Rungkitwattanakul, Dhakrit / Mere, Constance / Nwaogwugwu, Uzoamaka / Lawson, Pamela / Aldhaeefi, Mohammed / Chaijamorn, Weerachai / Hager, Katherine / Daftary, Monika

Hemodialysis international. International Symposium on Home Hemodialysis

2022 Volume 27, Issue 1, Page(s) 84–87

MeSH term(s)	Humans ; Mpox (monkeypox) ; Renal Dialysis
Language	English
Publishing date	2022-10-09
Publishing country	Canada
Document type	Letter
ZDB-ID	2192458-2
ISSN	1542-4758 ; 1492-7535
ISSN (online)	1542-4758
ISSN	1492-7535
DOI	10.1111/hdi.13048
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Article ; Online: Piperacillin-tazobactam dosing in anuric acute kidney injury patients receiving continuous renal replacement therapy.

Rungkitwattanakul, Dhakrit / Charoensareerat, Taniya / Chaichoke, Ekanong / Rakamthong, Thanakorn / Srisang, Pitchaya / Pattharachayakul, Sutthiporn / Srisawat, Nattachai / Chaijamorn, Weerachai

Seminars in dialysis

2023 Volume 36, Issue 6, Page(s) 468–476

Abstract: Introduction: To determine appropriate dosing of piperacillin-tazobactam in critically ill patients receiving continuous renal replacement therapy (CRRT).: Methods: The databases of PubMed, Embase, and ScienceDirect were searched. We used the Medical ...

Abstract	Introduction: To determine appropriate dosing of piperacillin-tazobactam in critically ill patients receiving continuous renal replacement therapy (CRRT). Methods: The databases of PubMed, Embase, and ScienceDirect were searched. We used the Medical Subject Headings of "piperacillin-tazobactam," "CRRT," and "pharmacokinetics" or related terms or synonym to identify the studies for reviews. A one-compartment pharmacokinetic model was conducted to predict piperacillin levels for the initial 48 h of therapy. The pharmacodynamic target was 50% of free drug level above the minimum inhibitory concentration (MIC) and 4 times of the MIC. The dose that achieved at least 90% of the probability of target attainment was defined as an optimal dose. Results: Our simulation study reveals that the dosing regimen of piperacillin-tazobactam 12 g/day is appropriate for treating Pseudomonal infection with KDIGO recommended effluent rate of 25-35 mL/kg/h. The MIC values of each setting were an important factor to design piperacillin-tazobactam dosing regimens. Conclusion: The Monte Carlo simulation can be a useful tool to evaluate drug dosing in critically ill acute kidney injury patients receiving CRRT when limited pharmacokinetic data are a concern. Clinical validation of these results is needed.
MeSH term(s)	Humans ; Anti-Bacterial Agents ; Continuous Renal Replacement Therapy ; Critical Illness/therapy ; Renal Dialysis ; Piperacillin, Tazobactam Drug Combination/pharmacokinetics ; Piperacillin/pharmacokinetics ; Acute Kidney Injury/therapy ; Microbial Sensitivity Tests ; Renal Replacement Therapy
Chemical Substances	Anti-Bacterial Agents ; Piperacillin, Tazobactam Drug Combination (157044-21-8) ; Piperacillin (X00B0D5O0E)
Language	English
Publishing date	2023-02-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	1028193-9
ISSN	1525-139X ; 0894-0959
ISSN (online)	1525-139X
ISSN	0894-0959
DOI	10.1111/sdi.13148
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Zs.A 2879: Show issues

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Article ; Online: Optimal Meropenem Dosing Regimens in Patients Undergoing Continuous Renal Replacement Therapy: Systematic Review and Monte Carlo Simulations.

Charoensareerat, Taniya / Chaijamorn, Weerachai / Kerdnimith, Pathakorn / Kosumwisaisakul, Nutsinee / Teeranaew, Piyakamol / Rungkitwattanakul, Dhakrit / Boonpeng, Apinya / Srisawat, Nattachai / Pattharachayakul, Sutthiporn

Blood purification

2023 Volume 52, Issue 6, Page(s) 503–515

Abstract: Introduction: The optimal meropenem dosing regimens in critically ill patients receiving continuous renal replacement therapy (CRRT) based on pharmacokinetic and pharmacodynamic (PD) concepts are not well established. This study aimed to (1) gather the ... ...

Abstract	Introduction: The optimal meropenem dosing regimens in critically ill patients receiving continuous renal replacement therapy (CRRT) based on pharmacokinetic and pharmacodynamic (PD) concepts are not well established. This study aimed to (1) gather the available published pharmacokinetic studies conducted in septic patients receiving CRRT and (2) to define the optimal meropenem dosing regimens in these populations via Monte Carlo simulations. Methods: We used Medical Subject Headings "meropenem," "continuous renal replacement therapy," and "pharmacokinetics" or related terms to identify studies for systematic review. A one-compartment pharmacokinetic model was conducted to predict meropenem levels for the initial 48 h of therapy. The PD targets were 40% of free drug above a threshold of 1 times the minimum inhibitory concentration (MIC) (40% fT > MIC), 4 times the MIC (40% fT > 4MIC), and an additional target of free drug level above 1 times MIC 100% of the time (fT > MIC). The dose that achieved at least 90% of the probability of target attainment (PTA) was defined as an optimal dose. Results: Twenty-one articles were included for our systematic review. The necessary pharmacokinetic parameters such as volume of distribution and CRRT clearance were cited in 90.5 and 71.4% of articles, respectively. None of the published studies reported completed necessary parameters. A regimen of 750 mg q 8 h was found to be the optimal dose for pre-dilution continuous venovenous hemofiltration and continuous venovenous hemodialysis modality using two effluent rates (25 and 35 mL/kg/h) which achieved the PD target of 40% fT > 4MIC. Conclusion: None of the published studies showed the necessary pharmacokinetic parameters. PD target significantly contributed to meropenem dosage regimens in these patients. Differing effluent rates and types of CRRT shared similar dosing regimens. Clinical validation of the recommendation is suggested.
MeSH term(s)	Humans ; Meropenem ; Continuous Renal Replacement Therapy ; Anti-Bacterial Agents/therapeutic use ; Monte Carlo Method ; Critical Illness/therapy ; Renal Replacement Therapy
Chemical Substances	Meropenem (FV9J3JU8B1) ; Anti-Bacterial Agents
Language	English
Publishing date	2023-05-05
Publishing country	Switzerland
Document type	Systematic Review
ZDB-ID	605548-5
ISSN	1421-9735 ; 0253-5068
ISSN (online)	1421-9735
ISSN	0253-5068
DOI	10.1159/000529694
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Article ; Online: Levetiracetam dosing in patients receiving continuous renal replacement therapy.

Chaijamorn, Weerachai / Charoensareerat, Taniya / Rungkitwattanakul, Dhakrit / Phunpon, Sathian / Sathienluckana, Thanompong / Srisawat, Nattachai / Pattharachayakul, Sutthiporn

Epilepsia

2021 Volume 62, Issue 9, Page(s) 2151–2158

Abstract: Objective: The study was aimed to define appropriate levetiracetam dosing regimens from available published pharmacokinetics (PK) studies in critically ill patients with and without cirrhosis receiving continuous renal replacement therapy (CRRT) via ... ...

Abstract	Objective: The study was aimed to define appropriate levetiracetam dosing regimens from available published pharmacokinetics (PK) studies in critically ill patients with and without cirrhosis receiving continuous renal replacement therapy (CRRT) via Monte Carlo simulation (MCS). Methods: Mathematical pharmacokinetic models were developed using published demographic and PK data in adult critically ill patients with known variability and correlations between PK parameters. CRRT modalities (continuous venovenous hemofiltration and continuous venovenous hemodialysis) with different effluent rates were modeled. Levetiracetam regimens from available clinical resources were evaluated on the probability of target attainment (PTA) using pharmacodynamics (PD) target of the trough concentrations and area under the time-concentration curve within a range of 6-20 mg/L and 222-666 mg × hour/L for the initial 72 hours of therapy, respectively. Optimal regimens were defined from regimens that yielded the highest PTA. Each regimen was tested in a group of different 10,000 virtual patients. Results: Our results showed the optimal levetiracetam dosing regimen of 750-1000 mg every 12 hours is recommended for adult patients receiving both CRRT modalities with two different effluent rates of 25 and 35 mL/kg/h. Child-Pugh class C cirrhotic patients undergoing CRRT required lower dosing regimens of 500-750 mg every 12 ours due to smaller non-renal clearance. Of interest, some of literature-based dosing regimens were not able to attain the PK and PD targets. Significance: Volume of distribution, non-renal clearance, CRRT clearance, and body weight were significantly correlated with the PTA targets. Dosing adaptation in this vulnerable population should be concerned. Clinical validation of our finding is absolutely needed.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Continuous Renal Replacement Therapy ; Critical Illness ; Humans ; Levetiracetam ; Monte Carlo Method
Chemical Substances	Anti-Bacterial Agents ; Levetiracetam (44YRR34555)
Language	English
Publishing date	2021-07-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	216382-2
ISSN	1528-1167 ; 0013-9580
ISSN (online)	1528-1167
ISSN	0013-9580
DOI	10.1111/epi.16971
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Article ; Online: Citrate pharmacokinetics in critically ill liver failure patients receiving CRRT.

Thanapongsatorn, Peerapat / Chaijamorn, Weerachai / Sirivongrangson, Phatadon / Tachaboon, Sasipha / Peerapornratana, Sadudee / Lumlertgul, Nuttha / Lucksiri, Aroonrut / Srisawat, Nattachai

Scientific reports

2022 Volume 12, Issue 1, Page(s) 1815

Abstract: Citrate has been proposed as anticoagulation of choice in continuous renal replacement therapy (CRRT). However, little is known about the pharmacokinetics (PK) and metabolism of citrate in liver failure patients who require CRRT with regional citrate ... ...

Abstract	Citrate has been proposed as anticoagulation of choice in continuous renal replacement therapy (CRRT). However, little is known about the pharmacokinetics (PK) and metabolism of citrate in liver failure patients who require CRRT with regional citrate anticoagulation (RCA). This prospective clinical PK study was conducted at King Chulalongkorn Memorial Hospital between July 2019 to April 2021, evaluating seven acute liver failure (ALF) and seven acute-on-chronic liver failure (ACLF) patients who received CRRT support utilizing RCA as an anticoagulant at a citrate dose of 3 mmol/L. For evaluation of the citrate PK, we delivered citrate for 120 min and then stopped for a further 120 min. Total body clearance of citrate was 152.5 ± 50.9 and 195.6 ± 174.3 mL/min in ALF and ACLF, respectively. The ionized calcium, ionized magnesium, and pH slightly decreased after starting citrate infusion and gradually increased to baseline after stopping citrate infusion. Two of the ACLF patients displayed citrate toxicity during citrate infusion, while, no ALF patient had citrate toxicity. In summary, citrate clearance was significantly decreased in critically ill ALF and ACLF patients receiving CRRT. Citrate use as an anticoagulation in these patients is of concern for the risk of citrate toxicity.
MeSH term(s)	Acute-On-Chronic Liver Failure/blood ; Acute-On-Chronic Liver Failure/diagnosis ; Acute-On-Chronic Liver Failure/physiopathology ; Acute-On-Chronic Liver Failure/therapy ; Adult ; Aged ; Aged, 80 and over ; Anticoagulants/administration & dosage ; Anticoagulants/adverse effects ; Anticoagulants/pharmacokinetics ; Citric Acid/administration & dosage ; Citric Acid/adverse effects ; Citric Acid/pharmacokinetics ; Continuous Renal Replacement Therapy/adverse effects ; Critical Illness ; Female ; Humans ; Kidney Diseases/blood ; Kidney Diseases/diagnosis ; Kidney Diseases/physiopathology ; Kidney Diseases/therapy ; Liver/metabolism ; Liver/physiopathology ; Liver Failure, Acute/blood ; Liver Failure, Acute/diagnosis ; Liver Failure, Acute/physiopathology ; Liver Failure, Acute/therapy ; Male ; Metabolic Clearance Rate ; Middle Aged ; Prospective Studies ; Treatment Outcome
Chemical Substances	Anticoagulants ; Citric Acid (2968PHW8QP)
Language	English
Publishing date	2022-02-02
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-022-05867-8
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