Serum Creatinine and Tacrolimus Assessment With VAMS Finger-Prick Microsampling: A Diagnostic Test Study

Rationale & Objective: Kidney transplant recipients require frequent venipunctures. Microsampling methods that use a finger-prick draw of capillary blood, like volumetric absorptive microsamplers (VAMS), have the potential to reduce the pain, inconvenience, and volume of blood loss associated with venipuncture. This study aimed to provide diagnostic accuracy using VAMS for measurement of tacrolimus and creatinine compared to gold standard venous blood in adult kidney transplant recipients. Study Design: Diagnostic test study. Prospective blood samples for measurement of tacrolimus and creatinine were collected using Mitra VAMS and venipuncture immediately before and 2 hours after tacrolimus dosing. Setting & Participants: A convenience sample of 40 adult kidney transplant participants in the outpatient setting. Tests Compared: Method comparison was assessed by Passing-Bablok regression and Bland-Altman analysis. The predictive performance of VAMS measurement compared to venipuncture was also assessed through estimation of the median prediction error and median absolute percentage prediction error. Results: A total of 74 tacrolimus samples and 70 creatinine samples were analyzed from 40 participants. Passing-Bablok regression showed a systematic difference between VAMS and venipuncture when measuring tacrolimus and creatinine with a slope of 1.08 (95% CI, 1.03-1.13) and a slope of 0.65 (95% CI, 0.6-0.7), respectively. These values were then corrected for the systematic difference. When used for Bland-Altman analysis, corrected values of tacrolimus and creatinine showed a bias of -0.1 μg/L and 0.04 mg/dL, respectively. Tacrolimus (corrected) and creatinine (corrected) microsampling values when compared to corresponding venipuncture values met median prediction error and median absolute percentage prediction error predefined acceptability limits of <15%. Limitations: This study was conducted in a controlled environment using a trained nurse to collect VAMS samples. Conclusions: In this study, VAMS was used to reliably measured tacrolimus and creatinine. This represents a clear opportunity for more frequent and less invasive sampling for patients

Complex prescribing in chronic kidney disease: role of the renal pharmacist in kidney supportive care in uncovering hydralazine-related lupus

Background: Herein we describe the presentation of drug-induced lupus in an 89-year-old woman with end-stage kidney disease (estimated glomerular filtration rate (eGFR) 11\ua0mL/min per 1.73\ua0m) who had chosen a conservative non-dialysis pathway of care, and highlight the role of a pharmacist in identifying drug-related problems. Clinical details: Among numerous health conditions, the patient had systemic lupus erythematosus (SLE) that had previously responded to hydroxychloroquine, which had been ceased. Hydralazine was subsequently commenced to control the patient's blood pressure. The combination of ceasing the medicine that controlled the patient's SLE and commencing a medicine that accumulates in patients with reduced renal function and can precipitate SLE resulted in a reactivation of the patient's disease. Outcomes: The pharmacist was pivotal in uncovering the timeline of medication changes and assisting in identifying SLE reactivation. Cessation of the patient's hydralazine and recommencing hydroxychloroquine resulted in the resolution of the symptoms. Conclusion: This case presents the value of an interdisciplinary approach to patient directed symptoms, when prescribing in the very complex clinical context of multiple comorbid conditions for patients with severely reduced renal function

Kidney transplant recipient’s perceptions of blood testing through microsampling and venepuncture

A survey of kidney transplant recipients receiving two innovative microsampling methods, dried blood spot and volumetric absorptive microsampling using patient reported methodology. A total of\ua039 adult transplant patients underwent venepuncture and finger prick-based blood draws on two occasions. They completed a survey of blood test understanding, tolerability, preferences and the burden associated with venepuncture compared with microsampling. A total of\ua085% of participants (n\ua0=\ua033) preferred finger prick-based sampling and 95% (n\ua0=\ua037) were interested in blood collection using self sampling by finger prick at home; 33% (n\ua0=\ua013) of participants experienced blood test anxiety. To quantify time burden of providing venous samples a total of 44% (n\ua0=\ua017) spent greater than 1 hour to travel and provide venous samples.\ua0This study observed a patient preference for microsampling for blood sampling as an alternative to venepuncture in the management of their kidney transplant

[Obesity and Eating Disorders. Indications for the different levels of care. An Italian Expert Consensus Document]. [Documento di Consensus. Obesità e Disturbi dell'Alimentazione Indicazioni per i diversi livelli di trattamento.]

This paper is an Italian Expert Consensus Document on multidimensional treatment of obesity and eating disorders. The Document is based on a wide survey of expert opinion. It presents, in particular, considerations regarding how clinicians go about choosing the most appropriate site of treatment for a given patient suffering from obesity and/or eating disorders: outpatient, partial hospitalization, residential rehabilitation centre, inpatient hospitalization. In a majority of instances obesity and eating disorders are long-term diseases and require a multiprofessional team-approach. In determining an initial level of care or a change to a different level of care, it is essential to consider together the overall physical condition, medical complications, disabilities, psychiatric comorbidity, psychology, behaviour, family, social resources, environment, and available services. We first created a review manuscript, a skeleton algorithm and two rating scales, based on the published guidelines and the existing research literature. As the second point we highlighted a number of clinical questions that had to be addressed in the specific context of our National Health Service and available specialized care units. Then we submitted eleven progressive revisions of the Document to the experts up to the final synthesis that was approved by the group. Of course, from point to point, some of the individual experts would differ with the consensus view. The document can be viewed as an expert consultation and the clinical judgement must always be tailored to the particular needs of each clinical situation. We will continue to revise the Document periodically based on new research information and on reassessment of expert opinion to keep it up-to-date. The Document was not financially sponsored