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Capacitat Predictiva De L'estimació De La Funció Renal Sobre La Cinètica D

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Capacitat Predictiva De L'estimació De La Funció Renal Sobre La Cinètica D Capacitat predictiva de l’estimació de la funció renal sobre la cinètica d’eliminació de ganciclovir María Eugenia Palacio Lacambra ADVERTIMENT. La consulta d’aquesta tesi queda condicionada a l’acceptació de les següents condicions d'ús: La difusió d’aquesta tesi per mitjà del servei TDX (www.tdx.cat) i a través del Dipòsit Digital de la UB (diposit.ub.edu) ha estat autoritzada pels titulars dels drets de propietat intel·lectual únicament per a usos privats emmarcats en activitats d’investigació i docència. No s’autoritza la seva reproducció amb finalitats de lucre ni la seva difusió i posada a disposició des d’un lloc aliè al servei TDX ni al Dipòsit Digital de la UB. No s’autoritza la presentació del seu contingut en una finestra o marc aliè a TDX o al Dipòsit Digital de la UB (framing). Aquesta reserva de drets afecta tant al resum de presentació de la tesi com als seus continguts. En la utilització o cita de parts de la tesi és obligat indicar el nom de la persona autora. ADVERTENCIA. La consulta de esta tesis queda condicionada a la aceptación de las siguientes condiciones de uso: La difusión de esta tesis por medio del servicio TDR (www.tdx.cat) y a través del Repositorio Digital de la UB (diposit.ub.edu) ha sido autorizada por los titulares de los derechos de propiedad intelectual únicamente para usos privados enmarcados en actividades de investigación y docencia. No se autoriza su reproducción con finalidades de lucro ni su difusión y puesta a disposición desde un sitio ajeno al servicio TDR o al Repositorio Digital de la UB. No se autoriza la presentación de su contenido en una ventana o marco ajeno a TDR o al Repositorio Digital de la UB (framing). Esta reserva de derechos afecta tanto al resumen de presentación de la tesis como a sus contenidos. En la utilización o cita de partes de la tesis es obligado indicar el nombre de la persona autora. WARNING. On having consulted this thesis you’re accepting the following use conditions: Spreading this thesis by the TDX (www.tdx.cat) service and by the UB Digital Repository (diposit.ub.edu) has been authorized by the titular of the intellectual property rights only for private uses placed in investigation and teaching activities. Reproduction with lucrative aims is not authorized nor its spreading and availability from a site foreign to the TDX service or to the UB Digital Repository. Introducing its content in a window or frame foreign to the TDX service or to the UB Digital Repository is not authorized (framing). Those rights affect to the presentation summary of the thesis as well as to its contents. In the using or citation of parts of the thesis it’s obliged to indicate the name of the author. UNIVERSITAT DE BARCELONA FACULTAT DE FARMÀCIA I CIÈNCIES DE L’ALIMENTACIÓ CAPACITAT PREDICTIVA DE L’ESTIMACIÓ DE LA FUNCIÓ RENAL SOBRE LA CINÈTICA D’ELIMINACIÓ DE GANCICLOVIR MARÍA EUGENIA PALACIO LACAMBRA 2018 UNIVERSITAT DE BARCELONA FACULTAT DE FARMÀCIA I CIÈNCIES DE L’ALIMENTACIÓ PROGRAMA DE DOCTORAT RECERCA, DESENVOLUPAMENT I CONTROL DE MEDICAMENTS CAPACITAT PREDICTIVA DE L’ESTIMACIÓ DE LA FUNCIÓ RENAL SOBRE LA CINÈTICA D’ELIMINACIÓ DE GANCICLOVIR Memòria presentada per María Eugenia PaLacio Lacambra per optar aL títol de doctor per la Universitat de BarceLona Directors: Dr. José Bruno Montoro Ronsano Dr. Josep Maria Suñé Negre Doctoranda: María Eugenia PaLacio Lacambra Tutor: Dr. Josep Maria Suñé Negre MARÍA EUGENIA PALACIO LACAMBRA 2018 LLISTAT DE PUBLICACIONS/ APORTACIONS Aquesta tesi consta de les següents publicacions: v 2 comunicacions a congressos: o Palacio-Lacambra, Maria-Eugenia; Comas-Reixach, Immaculada; Blanco- Grau, Albert; Suñé-Negre, Josep-Maria; Segarra-Medrano, Alfonso; Montero-Ronsano, José-Bruno. Comparison of the Cockcroft-Gault, MDRD and CKD-EPI equations for estimating ganciclovir clearance. 23th Congress of the EAHP. 21st – 23rd March 2018, Gothenburg (Sweden). o Palacio-Lacambra, Maria-Eugenia; Suñé-Negre, Josep-Maria; Montero- Ronsano, José-Bruno. Dosificación de ganciclovir en pacientes con insuficiencia renal según CKD-EPI. 63 Congreso de la SEFH. 8-10 NoVembre 2018, Palma de Mallorca (Espanya). A l’Annex 9.6 s’adjunten les dues comunicacions en format pòster i els respectius certificats. v 1 carta a l’editor: o Palacio-Lacambra ME; Montero-Ronsano JB. Uso de la fórmula de Cockcroft-Gault para el ajuste de dosis de los fármacos en insuficiencia renal: ¿hasta cuándo? Med Clin. 2018 Aug;151(4):167. Factor d’impacte: 1.168 (Q3, 94/154) Aquesta carta s’adjunta a l’Annex 9.7. v 1 article o Palacio-Lacambra ME, Comas-Reixach I, Blanco-Grau A, Suñé-Negre JM, Segarra-Medrano A, Montoro-Ronsano JB. Comparison of the Cockcroft- Gault, MDRD and CKD-EPI equations for estimating ganciclovir clearance. Br J Clin Pharmacol. 2018 Sep;84(9):2120-28. doi: 10.1111/bcp.13647. Factor d’impacte: 3.838 (Q1, 47/261) Aquest article s’adjunta a l’Annex 9.8. v 1 sessió clínica: o Ajuste de dosis de fármacos en insuficiencia renal. Problemática actual. XII Curs Actualització en Farmacoteràpia. Servei de Farmàcia, Hospital UniVersitari Vall d’Hebron, Nov 2017 (1 h lectiva, 0.2 crèdits). El certificat com a ponent d’aquesta sessió s’adjunta a l’Annex 9.9. Amor Vincit Omnia AGRAÏMENTS Aquesta tesi no hagués estat possible sense el treball, la col·laboració i el recolzament de moltes persones. En primer lloc, volia agrair al Servei de Farmàcia de l’Hospital Universitari Vall d’Hebron per haver-me proporcionat la infraestructura necessària i les eines adients per portar a terme aquest projecte. Especialment volia donar les gràcies al Dr Montoro, creador i impulsor convençut de la hipòtesi d’estudi, per la seva ajuda continua, el seu bon fer i per estar sempre disponible a escoltar, a fer créixer i a millorar la idea inicial. Sense tu res d’això hagués sigut una realitat. En segon lloc, Volia agrair al SerVei de Bioquímica Clínica la seVa col·laboració durant tots aquest anys, i especialment a l’Albert Grau i a l’Imma Reixach per sentir-los tant a prop en tot moment, amb moltes ganes d’ajudar i de que aquest projecte tirés endavant. També Volia donar les gràcies al Dr Suñé per la seVa tutela, els seus bons consells de redacció i sobre tot, pel seu bon tracte personal. A la Jana, companya i millor amiga, pel seu suport emocional durant aquest temps, per escoltar-me quan m’ha fet falta i per alegrar-se de cada assoliment com si fos seu. A la meVa família, per confiar i creure en mi des de sempre, per escoltar-me i animar- me a tirar endavant qualsevol projecte que em proposi. A l’Eli, el meu marit, pel seu amor infinit que fa que tot sigui possible al seu costat. I per últim a la Maria que, dintre de la meva panxeta, m’ha proporcionat el temps i la inspiració necessaris per escriure aquest llibre. També Volia agrair a totes aquelles persones a qui he deixat en un segon pla per haver de treballar la tesi, per la seVa comprensió, paciència i suport. Especialment a la Juliette qui, tot i deixar a un costat la meVa participació a l'escola fa un temps, em segueix considerant part de l'equip i m'obre les portes i el seu cor cada vegada que em veu. ÍNDEX ABREVIATURES 1 1. INTRODUCCIÓ 3 1.1 GANCICLOVIR 5 1.1.1 MECANISME D’ACCIÓ DEL GANCICLOVIR 5 1.1.2 USOS CLÍNICS DEL GANCICLOVIR 6 1.1.2.1 Infecció per CMV 6 1.1.2.2 Dosificació de ganciclovir 8 1.1.2.3 Toxicitat de ganciclovir 9 1.2 MONITORITZACIÓ FARMACOCINÈTICA DEL GANCICLOVIR 9 1.2.1 MONITORITZACIÓ DE NIVELLS PLASMÀTICS: CONCENTRACIÓ MÀXIMA (Cmax) I CONCENTRACIÓ MÍNIMA (Cmin) 10 1.2.2 MONITORITZACIÓ DE L’ÀREA SOTA LA CORBA DE CONCENTRACIONS PLASMÀTIQUES (AUC) 14 1.3 MALALTIA RENAL 18 1.3.1 AVALUACIÓ DE LA FUNCIÓ RENAL 20 1.3.1.1 Mesura de la TFG amb marcadors de filtració exògens 21 1.3.1.2 Estimació de la TFG amb marcadors de filtració endògens 21 1.3.1.2.1 Creatinina 21 1.3.1.2.2 Cistatina C 25 1.3.2 FÓRMULES D’ESTIMACIÓ DE LA FUNCIÓ RENAL 25 1.3.2.1 Fórmula de Cockcroft-Gault 26 1.3.2.2 Fórmula de MDRD 27 1.3.2.3 Fórmula de CKD-EPI 28 1.3.3 AJUST DE DOSI DE FÀRMACS EN IR PROBLEMÀTICA ACTUAL 30 1.3.3.1 Paper de les Agències Reguladores 31 1.3.3.2 Paper de les principals organitzacions internacionals 32 1.3.3.2.1 Chronic kidney disease and drug dosing: information for proViders 33 1.3.3.2.2 KDIGO controVersies conference drug prescribing in kidney disease: initiative for improVed dosing 33 2. HIPÒTESI 37 3. OBJECTIUS 41 4. MATERIAL I MÈTODES 45 4.1 DISSENY DE L’ESTUDI 47 4.2 POBLACIÓ DE L’ESTUDI 47 4.3 ESTIMACIÓ DE LA FUNCIÓ RENAL 49 4.4 DETERMINACIÓ DE LA CREATININA SÈRICA 52 4.5 DETERMINACIÓ DE NIVELLS PLASMÀTICS DE GANCICLOVIR 53 4.6 ANÀLISI FARMACOCINÈTICA 54 4.7 ANÀLISI ESTADÍSTICA 55 4.8 ESTABLIR NOVES RECOMANACIONS DE DOSI DE GANCICLOVIR 56 5. RESULTATS 59 5.1 DESCRIPCIÓ DE LA POBLACIÓ 61 5.1.1 Correlació entre les 5 fórmules d’estimació de funció renal a la població general 69 5.1.2 Correlació entre el grup d’aprenentatge i el grup de validació pels diferents paràmetres estudiats 70 5.2 CATEGORITZACIÓ DE LA POBLACIÓ SEGONS LA FUNCIÓ RENAL.
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