Background: Chronic kidney disease (CKD) is a highly prevalent disease worldwide. A basic pillar for the management of a patient with CKD is the safe use of drugs. Inadequate dosing of medication or contraindicated drugs in renal impairment can lead to negative outcomes. The primary objective was to analyse the drug prescriptions of patients with CKD from two primary care centres to see if they were optimally adapted to the patient's estimated glomerular filtration rate (eGFR). Methods: A retrospective observational study was conducted in two urban primary care centres. The study period was between September–October 2019. Patients over 18 years of age, with established CKD and with an eGFR less than 60 mL/min/1.73m² for at least three months were included. Their demographic data (age and sex) and clinical variables such as associated comorbidities, eGFR value were retrospectively registered. Finally, their medication plans were reviewed in order to detect: inappropriate prescribing (IP), defined as an incorrect dose/frequency or contraindicated drug according to the renal function of the patient; nephrotoxic drugs and drugs with a high sodium content. Results: A total of 273 patients were included. The most common patient profile was an elderly woman, polymedicated, with other concomitant diseases and with mild CKD. Two hundred and one IPs were detected, 13.9% of which were contraindicated drugs. Of all patients, 49.1% had been prescribed at least one IP on their medication plan, 93.8% had some potentially nephrotoxic drug and 8.4% had drugs with a high sodium content prescribed. Conclusions: Patients with CKD are at increased risk of medication-related problems. It is necessary to implement measures to improve the safety in the prescription of drugs in patients with CKD.

Cytomegalovirus (CMV) infection is a relevant cause of morbimortality in patients receiving allogeneic stem cell transplantation (allo-HCT). Foscarnet (FCN) is an effective drug against CMV administered intravenously and usually on an inpatient basis. The Home Care Unit (HCU) for hematologic patients at our hospital designed an at-home FCN administration model to avoid the hospitalization of patients requiring FCN treatment. This study analyzes whether the at-home administration of FCN is as safe and effective as its hospital administration. We collected and compared demographic, clinical, analytical, and economic data of patients with CMV infection post-allo-HCT who received FCN in the hospital (n = 16, 17 episodes) vs. at-home (n = 67, 88 episodes). The proportions of patients with cured CMV infections were comparable between the two groups (65.9% vs. 76.5%, p = 0.395). The median duration of FCN treatment was 15 (interquartile range [IQR] 9–23) and 14 (IQR 11–19) days in the HCU and inpatient cohorts, respectively (p = 0.692). There were no significant differences in the FCN toxicities between groups except for hypocalcemia (26.1% vs. 58.8%, p = 0.007), which was more prevalent in the inpatient cohort. A significant cost-effectiveness was found in the HCU cohort, with a median savings per episode of EUR 5270. It may be concluded that home administration of FCN is a safe, effective, and cost-efficient therapeutic option for patients with CMV infection and disease.

Introducción: Voriconazol presenta una alta variabilidad interindividual en sus concentraciones plasmáticas (Cp). Los objetivos son: (i) describir sus Cp en una cohorte adulta, (ii) estudiar sus potenciales causas de variabilidad y (iii) relacionarlas con las recomendaciones de monitorización farmacocinética actuales. Método: Estudio observacional retrospectivo, incluyendo pacientes con ≥1 determinación de Cp mínima (C_min) de voriconazol durante 2017. Resultados: Se analizaron 165 C_min correspondientes a 51 pacientes. La mediana de C_min fue de 2,4µg/mL (IQR:1,4-3,6), siendo 4µg/mL en 34. Se observaron C_min significativamente superiores en >65 años (p=0,006) y en pacientes con albúmina <27g/L (p<0,001). Siguiendo las recomendaciones de monitorización de las Cp de voriconazol según la guía ESCMID-ECMM-ERS, se detectarían el 91,1% de C_min que resultaron fuera de intervalo. Conclusiones: Observamos un 36,4% de las C_min de voriconazol fuera del intervalo óptimo. Identificamos la edad y la concentración de albúmina como factores que influencian las Cp.

Early cardiac events (ECE) are a recognized cause of morbidity and mortality after allogeneic hematopoietic cell transplantation (allo-HCT), especially with the widespread use of post-transplant cyclophosphamide (PTCy) for graft-versus-host disease (GVHD) prophylaxis. Identifying patients at risk for ECE is crucial to optimize preventive strategies and improve outcomes. To validate the predictive performance of the CARE-BMT score for identifying patients at risk of ECE after allo-HCT and to determine whether incorporating PTCy exposure enhances its prognostic value. A retrospective cohort study including 593 adult patients who underwent allo-HCT between 2011 and 2023 at a single institution. ECE was defined as any new cardiac event within 100 days post-HCT. The CARE-BMT score-based on age, race, cardiac comorbidities, serum creatinine, triglyceride levels, and prior anthracycline exposure-was applied to stratify patients into intermediate- and high-risk groups. A modified-CARE-BMT score was developed by adding two points for standard-dose PTCy exposure. Survival analyses, cumulative incidence functions, and multivariate regression models were used to assess associations. ECE occurred in 47 patients (7.9%), with a median onset at 21 days post-HCT, and was associated with inferior one-year overall survival (48.6% vs. 75.0%, p<0.001). The CARE-BMT score stratified patients into intermediate- and high-risk groups with Day +100 ECE incidences of 5.8% and 11.2%, respectively (p=0.033). Standard-dose PTCy (50 mg/kg/day) was independently associated with increased ECE risk (p=0.014). The modified-CARE-BMT score stratified patients into low-, intermediate-, and high-risk groups with respective ECE incidences of 4.5%, 9.5%, and 12.7% (p=0.037). EASIX trajectories further supported the stratification capability of the modified model. The CARE-BMT score effectively predicts early cardiac events in allo-HCT recipients. Incorporating PTCy exposure into a modified risk model enhances its discriminatory power, allowing improved identification of high-risk patients who may benefit from tailored cardioprotective interventions and monitoring strategies.

Home hospitalization, and other models of outpatient care models, represents an alternative to traditional hospitalization, providing comparable clinical safety and efficacy for hematological patients. At-home therapies can range from the delivery of intravenous antibiotics to more complex scenarios such as the care during the early period after hematopoietic stem cell transplantation. Early discharge from conventional hospitalization is feasible, contributing to a reduction in hospital resource utilization and waiting lists, as well as to a better quality of life and level of patient satisfaction. The coordinated efforts of multidisciplinary teams, including hematologists, nurses, and pharmacists, ensure patient safety and continuity of care. The active involvement of a clinical pharmacist in home hospitalization programs is essential, not only for the proper logistical management of the medication but also to ensure its appropriateness, optimize treatment, address queries from the team and patients, and promote adherence.