For NHD, dialysate concentrations need to be
adjusted especially increasing calcium and decreasing bicarbonate concentration, phosphate supplementation may be required and blood and dialysate flow rates can often be lowered. Treatment frequency and/or duration of HD regimens may also need to be adjusted to meet clearance targets and normalize blood pressure, extracellular fluid volume and serum parameters. The author gratefully acknowledges the expertise of Professor Peter Kerr (Monash Medical Centre, Clayton), Associate Professor John Agar (Barwon Health, Geelong) and the home haemodialysis nursing staff at Barwon Health (Geelong, Victoria) for their assistance in reviewing this manuscript. “
“The Australian and New Zealand Society Torin 1 cost of Nephrology gratefully acknowledges the support of the following companies: Sustaining Member/Education Partner/Research Partner Roche Products Pty Ltd Sustaining Members/Education Partners Baxter Healthcare Pty Ltd Janssen-Cilag Pty Ltd Novartis Pharmaceuticals Australia Pty Ltd Pfizer Australia Pty Ltd Sanofi Shire Australia Pty Ltd Sustaining Member/Research Partner Amgen Australia Pty Ltd Sustaining Members check details Fresenius Medical Care Australia Pty Ltd Gambro Pty Ltd Servier Laboratories Australia
Pty Ltd “
“Aim: To determine the proportion of patients achieving tacrolimus whole-blood concentrations of ≥10 ng/mL within 3 days of kidney transplantation, after randomization either to standard dosing (control group) or post-transplantation dosing guided by a 2-hour (C2) level following a preoperative tacrolimus dose (T2 group). Methods: The first postoperative tacrolimus dose was given either according to standard care (control group) or 0.15 mg/kg b.d. if the pre-transplant C2 level was ≤20 ng/mL, 0.1 mg/kg b.d. if the C2 level was 21–59 ng/mL or 0.05 mg/kg b.d. if the C2 level was ≥60 ng/mL (T2 group). Subsequent dosing in both groups was based upon tacrolimus trough level monitoring. Participants received concomitant mycophenolate mofetil and steroids. Results: Ninety patients were recruited, of which 84 were included in the analysis (control group n = 43; T2 group n = 41). There was no
difference in the proportion of subjects achieving tacrolimus trough levels ≥10 ng/mL (82.9% Control vs Tyrosine-protein kinase BLK 93.0% T2; P = 0.19) or between 10 and 15 ng/mL (41.5% Control vs 41.9% T2; P = 0.97) at day 3 post transplant. The T2 group achieved tacrolimus trough levels of ≥10 ng/mL significantly faster than the control group (100% achievement in 14 days (Control) versus 4 days (T2); P = 0.01). Conclusion: Performing a pre-transplant tacrolimus C2 does not significantly increase the high proportion of subjects achieving 10 ng/mL tacrolimus concentrations by day 3 using routine protocols. However, compared with standard care, performing a pre-transplant tacrolimus C2 does lead to patients achieving a whole-blood concentration of ≥10 ng/mL sooner.