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Evaluation of sulfobutylether-β-cyclodextrin (SBECD) accumulation and voriconazole pharmacokinetics in critically ill patients undergoing continuous renal replacement therapy

Overview of attention for article published in Critical Care, December 2015
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  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (88th percentile)
  • Above-average Attention Score compared to outputs of the same age and source (58th percentile)

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18 X users

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66 Mendeley
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Title
Evaluation of sulfobutylether-β-cyclodextrin (SBECD) accumulation and voriconazole pharmacokinetics in critically ill patients undergoing continuous renal replacement therapy
Published in
Critical Care, December 2015
DOI 10.1186/s13054-015-0753-8
Pubmed ID
Authors

Tyree H Kiser, Douglas N Fish, Christina L Aquilante, Joseph E Rower, Michael F Wempe, Robert MacLaren, Isaac Teitelbaum

Abstract

IntroductionIntravenous (IV) voriconazole is not recommended in patients with creatinine clearance <50 ml/min to avoid potentially toxic accumulation of sulfobutylether-ß-cyclodextrin (SBECD). The purpose of this study was to evaluate the pharmacokinetics of SBECD, voriconazole, and voriconazole N-oxide in critically ill patients undergoing continuous renal replacement therapy (CRRT) and to determine if CRRT removes SBECD sufficiently to allow for the use of IV voriconazole without significant risk of SBECD accumulation.MethodsThis prospective, open-label pharmacokinetic study enrolled patients >18 years old receiving IV voriconazole for a known or suspected invasive fungal infection while undergoing CRRT. Serial blood and effluent samples were collected on days 1, 3, 5, 7, and every 3 to 5 days thereafter. SBECD, voriconazole, and voriconazole N-oxide plasma and effluent concentrations were measured by liquid chromatography-tandem mass spectrometry. Pharmacokinetic, pharmacodynamic, and pharmacogenetic analyses were conducted.ResultsTen patients (mean¿±¿standard deviation (SD)) 53¿±¿11 years old, 50% male, 81¿±¿14 kg, with Acute Physiologic and Chronic Health Evaluation II (APACHE II) scores of 31.5¿±¿3.8 were evaluated. All patients underwent continuous veno-venous hemofiltration (CVVH) with a median predilution replacement fluid rate of 36 (interquartile range (IQR) 32 to 37) ml/kg/hr and total ultrafiltration rate of 38 (IQR 34 to 39) ml/kg/hr. Mean¿±¿SD voriconazole and SBECD dosages administered were 8.1¿±¿2.1 mg/kg/day and 129¿±¿33 mg/kg/day, respectively. Voriconazole plasma trough concentrations were >1 mg/L in all patients with CVVH accounting for only 15% of the total body clearance. CVVH accounted for 86% of the total body clearance of SBECD with the majority of the dose being recovered in the effluent. Minimal increases in dose normalized SBECD area under the concentration-time curve from 0 to 12 hours (AUC0¿12) (4484¿±¿4368 to 4553¿±¿2880 mg*hr/L; P¿=¿0.97) were observed after study day 1.ConclusionsCVVH effectively removed SBECD at a rate similar to the ultrafiltration rate. Voriconazole clearance by CVVH was not clinically significant. Standard dosages of IV voriconazole can be utilized in patients undergoing CVVH without significant risk of SBECD accumulation.Trial registrationClinicalTrials.gov NCT01101386. Registered April 6 2010.

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X Demographics

The data shown below were collected from the profiles of 18 X users who shared this research output. Click here to find out more about how the information was compiled.
Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 66 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 66 100%

Demographic breakdown

Readers by professional status Count As %
Other 8 12%
Researcher 8 12%
Student > Bachelor 6 9%
Student > Ph. D. Student 5 8%
Student > Doctoral Student 3 5%
Other 15 23%
Unknown 21 32%
Readers by discipline Count As %
Medicine and Dentistry 21 32%
Pharmacology, Toxicology and Pharmaceutical Science 14 21%
Chemistry 2 3%
Agricultural and Biological Sciences 2 3%
Computer Science 1 2%
Other 6 9%
Unknown 20 30%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 13. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 08 January 2022.
All research outputs
#2,813,200
of 25,584,565 outputs
Outputs from Critical Care
#2,418
of 6,588 outputs
Outputs of similar age
#44,745
of 396,604 outputs
Outputs of similar age from Critical Care
#194
of 466 outputs
Altmetric has tracked 25,584,565 research outputs across all sources so far. Compared to these this one has done well and is in the 88th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 6,588 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 20.8. This one has gotten more attention than average, scoring higher than 63% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 396,604 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 88% of its contemporaries.
We're also able to compare this research output to 466 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 58% of its contemporaries.