Patient information leaflets are universally-accepted resources to educate the patients/users about their medications, disease and lifestyle modification. The objective of the study was to prepare, validate and perform user-testing of pictogram-based patient information leaflets (P-PILs) among hemodialysis (HD) patients. The P-PILs are prepared by referring to the primary, secondary and tertiary resources. The content and pictograms of the leaflet have been validated by an expert committee consisting of three nephrologists and two academic pharmacists. The Baker Able Leaflet Design has been applied to develop the layout and design of the P-PILs. Quasi-experimental pre- and post-test design without control group was conducted on 81 HD patients for user-testing of P-PILs. The mean Baker Able Leaflet Design assessment score for English version of the leaflet was 28, and 26 for Kannada version. The overall user-testing knowledge assessment mean scores were observed to have significantly improved from 44.25 to 69.62 with p value <0.001. The overall user opinion of content and legibility of the leaflets was good. Pictogram-based patient information leaflets can be considered an effective educational tool for HD patients.

North Am J Med Sci, Official publication of ,Canada

Background: Estimating the glomerular filtration rate (eGFR) when the creatinine (Cr) is rapidly changing, as in acute kidney injury (AKI), has been a challenge. The Kinetic Estimated Glomerular Filtration Rate (KeGFR) formula by S. Chen estimates the GFR in the acute state by factoring the time interval between rising Cr values and the volume of distribution (V_D). It provides the clinician with an eGFR value for each non-steady state Cr value. We applied the KeGFR formula to detect AKI in an adult non-ICU inpatient setting. We then compared KeGFR with the current standard Acute Kidney Injury Network (AKIN criteria) and Risk Injury Failure Loss End-Stage Kidney Disease (RIFLE criteria) and new criteria (Waikar-Bonventre, Delta check) for AKI detection. Methods: A total of 250 consecutive adult patients admitted to the Medical wards were screened. Patient episodes with a change in Cr of > 4.3% (Biological Variation) were included in the study (n = 80). The KeGFR equation was applied to this cohort after calculating the V_D individually after estimating the initial GFR by using MDRD equation. A fall in KeGFR of 25% or more was considered as AKI. The AKIN, Waikar-Bonventre, RIFLE, and Delta Check criteria were also applied to this cohort and compared with the KeGFR criterion. Clinical adjudication was performed when there was discordance between AKI episodes detected by AKIN and KeGFR criteria. Results: There were 50 episodes of AKI by AKIN classification and 31 episodes by KeGFR criterion. All but 1 (30) episode detected by KeGFR criterion fulfilled the AKI definition by AKIN. AKIN diagnosed an additional 20 episodes. However, all of these had an elevated Cr level on admission; thus, requiring the incorporation of baseline Cr by AKIN which is not part of the KeGFR formula. Five of these 20 patients were deemed as not having AKI by clinical adjudication. All patients with in-hospital AKI and ongoing AKI were detected by both the criteria. The KeGFR criteria detected almost all (24/25) episodes of AKI identified by the Waikar-Bonventre method. The latter method detected 77% (24/31) of the AKI episodes identified by KeGFR. Conclusion: The KeGFR equation can be readily applied to estimate GFR in the non-steady state. A KeGFR-based criterion successfully detected ongoing and in-hospital AKI in this study. Community acquired AKI that did not progress after admission was not detected by the KeGFR criterion.

Introduction: Drug dosing in patients with acute kidney injury (AKI) is based on the Cockroft-Gault (CG) equation-derived estimated Creatinine clearance (CGeCrCl) for historical reasons due to the lack of a validated method for estimating glomerular filtration rate (GFR) when Cr is rapidly changing. The kinetic equation (kinetic estimated GFR [KeGFR]) estimates GFR for the nonsteady-state Cr level. It is being validated in patient cohorts and could potentially be used for drug dosing when the Cr level is in the nonsteady state. Objective: The aim of the study was to measure the concordance and the degree of agreement between KeGFR-, CGeCrCl, and MDRD eGFR-based drug dosing categories in patients with nonsteady Cr levels. Methods: In the pilot study published previously, 80 adult patients with a significant change in Cr level after admission to the acute medical ward were classified as per the Acute Kidney Injury Network (AKIN) criteria and compared to a KeGFR-based criterion. The CG equation and the MDRD equation were applied retrospectively to the same dataset, and the concordance of the eGFR categories between the 3 methods was studied. The 3 eGFR categories (50 mL/min) were chosen to reflect the frequently used drug dosing categories in patients with renal impairment. Results: The concordance between CGeCRCL and KeGFR for drug dosing categories was only 62%, with 27 (90%) of the 30 discordant subjects falling into a higher eGFR category when KeGFR was used. The agreement between KeGFR and CGeCrCl was also unsatisfactory. There was better concordance (75%), but the agreement was also not satisfactory between MDRD eGFR and KeGFR for the drug dosing categories. Conclusions: In AKI, compared to CGeCrCL, using KeGFR may affect drug dosing significantly by changing the eGFR category. Further studies of KeGFR for drug dosing will need therapeutic drug monitoring and pharmacokinetic studies for validation.