Population pharmacokinetics of teicoplanin in hospitalized elderly patients using cystatin C as an indicator of renal function
Population pharmacokinetics of teicoplanin in hospitalized elderly patients using cystatin C as an indicator of renal function
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DOI：
10.1016/j.jiac.2017.12.002
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发表时间：
2018-04-01
影响因子：
2.2
通讯作者：
Yamamoto, Yoshihiro
中科院分区：
文献类型：
--
作者：
Kasai, Hidefumi;Tsuji, Yasuhiro;Yamamoto, Yoshihiro
目的：血清胱抑素C（CysC）最近被提议作为血清肌酐（SCR）的替代指标，用于估计肾清除率。在本研究中，我们进行了替考拉宁（TEIC），这主要是通过肾脏消除的群体药代动力学分析，使用CysC作为肾clearance.Methods的预测：36例MRSA感染谁被管理到国立医院组织别府医疗中心在2012年1月至2013年12月期间入组，并给出了123套血液TEIC浓度数据。使用CysC通过Hoek方程、使用SCR通过Cockcroft-Gault方程预测的肌酐清除率或直接通过CysC估计肾清除率。采用具有个体间变异性的肾清除率和分布容积的一室开放模型以及一个附加的残差模型估计TEIC的群体药代动力学参数。结果：具有最佳预测性的模型是以CysC作为肾清除率预测因子的模型;该模型的显著性优于用Hoek方程或CLcr估计肾小球滤过率的模型。最终模型如下：CL（L/hr）= 0.510 x（CysC/1.4）（-0.68）x总体重/60（0.81），ω（CL）= 19.8%CV，VC（L）= 78.1，ω（V）= 42.7%CV。本研究结果表明，CysC的有用性，更准确地预测药物的药代动力学主要通过肾脏消除，如TEIC。然而，由于本研究中的样本量相对较小，因此需要使用CysC进一步研究肾清除率的可预测性。(c)2017年日本化疗学会和日本传染病协会。由爱思唯尔有限公司出版。保留所有权利。
Objective: Serum cystatin C (CysC) has recently been proposed as an alternative marker to serum creatinine (SCR) for estimating renal clearance. In the present study, we performed a population pharmacokinetic analysis of teicoplanin (TEIC), which is mainly eliminated through the kidneys, using CysC as a predictor for renal clearance.Methods: Thirty-six patients with MRSA infections who were administrated to the National Hospital Organization Beppu Medical Center between January 2012 and December 2013 were enrolled and gave 123 sets of blood TEIC concentration data. Renal clearance was estimated by the Hoek equation using CysC, by creatinine clearance predicted by the Cockcroft-Gault equation using SCR, or directly by CysC. One compartment open model with inter-individual variabilities for renal clearance and the volume of distribution as well as an additional residual error model was used to estimate population pharmacokinetic parameters for TEIC.Results: The model with the best predictability was that with CysC as a predictor for renal clearance; it showed better significance than the models using estimated the glomerular filtration rate by the Hoek equation or CLcr. The final model was as follows: CL (L/hr) = 0.510 x (CysC/1.4)(-0.68) x Total body weight/60(0.81), omega (CL) = 19.8% CV, VC (L) = 78.1, omega (V) = 42.7% CV.Conclusion: The present results show the usefulness of CysC to more accurately predict the pharmacokinetics of drugs mainly eliminated through the kidneys, such as TEIC. However, since the sample size in this study was relatively small, further investigations on renal clearance predictability using CysC are needed. (c) 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.