Comparison of Three Renal Function Formulas for Ganciclovir/Valganciclovir Dose Individualization in CMV-Infected Solid Organ Transplantation Patients Using a Population Approach.

BACKGROUND AND OBJECTIVE: The gold standard treatment of established cytomegalovirus infection or prevention in solid organ transplantation is the intravenous administration of ganciclovir (GCV) or oral administration of valganciclovir (VGCV), both adjusted to the renal function. In both instances, there is a high interindividual pharmacokinetic variability, mainly owing to the wide range of variation of both the renal function and body weight. Therefore, accurate estimation of the renal function is crucial for GCV/VGCV dose optimization. This study aimed to compare three different formulas for estimating the renal function in solid organ transplantation patients with cytomegalovirus infection, for individualizing antiviral therapy with GCV/VGCV, using a population approach. METHODS: A population pharmacokinetic analysis was performed using NONMEM 7.4. A total of 650 plasma concentrations obtained after intravenous GCV and oral VGCV administrations were analyzed, from intensive and sparse sampling designs. Three different population pharmacokinetic models were built with the renal function given by Cockcroft-Gault, Modification of Diet in Renal Disease, or Chronic Kidney Disease EPIdemiology Collaboration (CKD-EPI) formulas. Pharmacokinetic parameters were allometrically scaled to body weight. RESULTS: The CKD-EPI formula was identified as the best predictor of between-patient variability in GCV clearance. Internal and external validation techniques showed that the CKD-EPI model had better stability and performed better compared with the others. CONCLUSIONS: The model based on the more accurate estimation of the renal function with the CKD-EPI formula and body weight as a size metric most used in the clinical practice can refine initial dose recommendations and contribute to GCV and VGCV dose individualization when required in the prevention or treatment of cytomegalovirus infection in solid organ transplantation patients.

Peligros en la utilización de cabinas de desinfección contra el SARS-CoV-2 / Hazards in the use of disinfection cabinets against SARS-CoV-2

La pandemia producida por el coronavirus SARS-CoV-2 está causando estragos sanitarios y económicos en todo el mundo, obligando a la reorientación de recursos para disminuir el contagio y superar los problemas económicos. En ese sentido se comenzaron a construir y emplear las cabinas de desinfección para eliminar el SARS-CoV-2 de forma externa, las cuales eran colocadas en las entradas de los hospitales para rociar con agentes desinfectantes a las personas que entraban y salían del lugar, a pesar de que los productos empleados están habilitados para ser utilizados sobre objetos y por un tiempo determinado, lo cual representaba un riesgo para la salud del usuario por lo que se requería de un estudio para establecer los peligros relacionados y desaconsejar su utilización.

The pandemic produced by the SARS-CoV-2 coronavirus is causing health and economic havoc throughout the world, forcing the redirection of resources to reduce contagion and overcome economic problems. In this sense, they began to build and use disinfection cabins to eliminate SARS-CoV-2 externally, which were placed at the entrances of hospitals to spray disinfectants with disinfectants to people who entered and left the place, despite the fact that the products used are enabled to be used on objects and for a certain time, which represented a risk to the health of the user, so a study was required to establish the related dangers and advise against their use.