Abstract
Background and Aims
Calcific uremic arteriolopathy (CUA), also referred to as calciphylaxis, is a rare and serious complication in patients with advanced kidney disease. CUA has limited ...treatment options and poor prognosis, with one- year survival often reported to be below 50% after diagnosis 1,2. Hyperbaric oxygen therapy (HBOT) may improve wound healing by increasing tissue oxygenation, and has been suggested as adjuvant treatment for CUA patients 3. We added HBOT to our conventional multidisciplinary care of CUA patients in 2012 and this study aims to evaluate long- term outcomes of CUA patients after this.
Method
Data from all CUA patients treated at our institution from 2012 to 2022 were retrospectively retrieved from hospital records. This is a single-centre study, but patients from different Norwegian hospitals were referred for treatment at our centre. Conventional multidisciplinary care of CUA in our centre included sodium-thiosulphate, dialysis if indicated medical optimization of calcium- phosphate homeostasis, substitution of vitamin K2, withdrawal of warfarin and iron and vitamin D if used, minimization of systemic steroids, in addition to optimization of weight- and nutritional status. Our centre is restrictive with surgical revisions to CUA patients.
Results
25 CUA patients received a total number of 1493 HBOT treatments in addition to conventional CUA multidisciplinary care in the study period. Median HBOT per patient was 45 (range 1–267). One year after CUA diagnosis, 20 out of 25 patients were alive (80%). Fifteen out of the 20 patients, who were alive at one year after CUA diagnosis, had completely resolved CUA lesions (75%). Five patients died within the first year after CUA diagnosis, due to acute cardiovascular disease (n = 3) and infection (n = 2). Our impression is that HBOT is well- tolerated and associated with less wound- associated pain.
Conclusion
Our results suggest that HBOT is well- tolerated in CUA patients. After we included HBOT in our multidisciplinary care of CUA patients, 80% of the patients were alive one- year after CUA diagnosis.
Background
Existing PK models of propofol include sparse data from very obese patients. The aim of this study was to develop a PK model based on standardised surgical conditions and spanning from ...normal‐weight up to, and including, a high number of very obese patients.
Methods
Adult patients scheduled for laparoscopic cholecystectomy or bariatric surgery were studied. Anaesthesia was induced with propofol 2 mg/kg adjusted body weight over 2 min followed by 6 mg/kg/h adjusted body weight over 30 min. For the remainder of the operation anaesthesia was maintained with sevoflurane. Remifentanil was dosed according to clinical need. Eight arterial samples were drawn in a randomised block sampling regimen over a span of 24 h. Time‐concentration data were analysed by population PK modelling using non‐linear mixed‐effects modelling.
Results
Four hundred and seventy four serum propofol concentrations were collected from 69 patients aged 19–60 years with a BMI 21.6–67.3 kg/m2. Twenty one patients had a BMI above 50 kg/m2. A 3‐compartment PK model was produced wherein three different body weight descriptors and sex were included as covariates in the final model. Total body weight was found to be a covariate for clearance and Q3; lean body weight for V1, V2 and Q2; predicted normal weight for V3 and sex for V1. The fixed allometric exponent of 0.75 applied to all clearance parameters improved the performance of the model. Accuracy and precision were 1.4% and 21.7% respectively in post‐hoc performance evaluation.
Conclusion
We have developed a new PK model of propofol that is suitable for all adult weight classes. Specifically, it is based on data from an unprecedented number of individuals with very high BMI.
