The Renal Pharmacist

The RPN started 2008 off with a bang and the excitement continues!

This spring we held our first annual Nephrology Education Day on March28 2008. We heard great speakers and exciting topics. It was a great dayfor renal pharmacists from across Canada to network and exchange ideasand practices. We are planning for another Nephrology Education day in2009, so keep your eyes open for our upcoming announcements!

Joanne Jung has a great report on the CSN AGM in London in this newslet-ter edition. I want to thank all the pharmacists who came to our secondjoint conference with the CSN. It was a great conference and the execu-tive looks forward to hearing from you for any feedback and suggestionsfor future joint conferences with the CSN.

We are also gearing up for our fall CE event in Ontario with Dr RobertQuinn giving a talk on anticoagulation in the hemodialysis Patient. He willshare with us some of the controversies and of course his recently pub-lished paper in this area! The BC Pharmacists will also hold their first RPNCE night in Vancouver on November 5 2008! It is so great to see the RPNgrow nationally!

I want to personally thank all the executive members of the RPN for alltheir valuable contribution and time. It has been a great and successfulyear! I would also like to take this opportunity to thank all our corporatesponsors because without your generous contributions, the RPN would notbe able to fulfill its mission! THANK YOU!

See you all soon!

Sincerely,Marisa Battistella, Chair 2008

Chair:Marisa BatistellaUniversity Health NetworkPH: (416) 340-4800 ext [email protected]

Co Vice-Chairs:Karen Shalansky, Pharm.D.Pharmacotherapeutic Specialist -NephrologyVancouver General HospitalClinical ProfessorUniversity of British ColumbiaPH: 604-875-4839Fax: 604-875-5267email: [email protected]

Joanne Jung, BScPharm, ACPRClinical Pharmacist - HemodialysisSt. Paul's Hospital1081 Burrard St, Vancouver, BCPH: 604-806-9399email: [email protected]

Education Coordinators:Jenny NgSunnybrook & Women’s CollegeHealth Science CentrePH: (416) 480-6100 ext. [email protected]

CommunicationsCoordinators:Reshma DoleLakeridge Health Corp.PH: (905) 576-8711 ext [email protected]

Ryan LeppertLakeridge Health Corp.PH: (905) 576-8711 ext [email protected]

Website Coordinator:Jiten JaniCredit Valley HospitalPH: (905) 813-1100 ext. [email protected]

Past Chair:Stephanie OngUniversity Health NetworkPh: (416) 340-4800 ext. [email protected]

ADDRESS/INFO CHANGES

Please forward any address / phonenumber changes to the Website co-ordinator [email protected]. We are constantly updating our membership mailing list. Thank you

The Renal PharmacistVolume 11, Issue 2 Fall 2008

View from the Chair

CHECK OUT OUR WEBSITE AT www.renalpharmacists.net

The Renal Pharmacist - Fall 2008 1

Antibiotic Lock Technique..........................................................................................2DI PD Exit Site..............................................................................................................4Final Abx In PD Solutions...........................................................................................6Member Profile ...........................................................................................................7RPN Western Conference............................................................................................8Website of Interest......................................................................................................9Articles of Interest.......................................................................................................9Upcoming Conferences...............................................................................................9Sponsors.....................................................................................................................10

IN THIS ISSUE . . .

The antibiotic lock technique is a relatively newtechnique used to prevent and treat catheter-related infections, which involves instilling anantibiotic solution into the catheter and havingit dwell for a specified amount of time. Highconcentrations of antibiotic are needed withinthe catheter in order to be effective, especiallyif fibrous material and biofilm are thought tobe present. The ultimate goal of this techniqueis to eradicate or prohibit growth of the infect-ing organism and help to prolong the life ofthe catheter.1 The antibiotic lock technique is awell tolerated alternative to treating suchinfections with systemic antibiotics and it isusually effective at treating central venouscatheter infections provided they do notinvolve the insertion site, tunnel site and thebacteria is susceptible to the antibiotic beingused.1 Furthermore, antibiotic lock techniqueled to a significant reduction in hospital staysfor infected patients compared to those treat-ed with systemic therapy alone and provided asubsequent infection free period of 74-152days.2 The antibiotics that have evidence fortheir efficacy when used in this technique areceftriaxone, vancomycin, gentamycin,ciprofloxacin, cefazolin, aztreonam and ticar-cillin/clavulanic acid, which all lose less than10% of their activity after seven days of use.3

There is an ongoing discussion if antibiotic locktechnique can be used alone or if it should beused in combination with systemic antibiotics.The theory is that the antibiotic lock would killall the bacteria in the catheter while the sys-temic antibiotics would treat any bacteria thathad infected the patient and were makingthem symptomatic.1 One study has shown thatninety percent of patients were successfullytreated with antibiotic lock and systemicantibiotics, but the same percentage ofpatients were also successfully treated withantibiotic lock alone.2 Other similar studieshave been conducted and concluded that theredoes not appear to be any difference in curerate between antibiotic lock alone or whenused in combination with systemic therapy. Theclearance of the infection from the catheter

with either antibiotic lock alone or the combi-nation is usually achieved with one to twoweeks of therapy.1

A major dilemma with antibiotic lock is com-patibility with heparin since these two fluidswould have to be used in conjunction with oneanother. Very few in vivo studies have beendone to test that both the antibiotic(s) andheparin maintain their efficacy when used inconjunction. However, there have been many invitro studies done that measured antibacterialactivity and that appropriate anti-coagulationwas maintained throughout therapy. Two stud-ies have shown that when vancomycin is usedin antibiotic lock the heparin activity is main-tained 4,5 and one study has shown the same tobe true when ciprofloxacin is used with thevancomycin and heparin.5 In terms of antibac-terial activity the results were dependent uponthe antibiotic agent used. One study showedthat a combination of vancomycin,ciprofloxacin and heparin remained as effectiveas either antibiotic used alone5, but anotherstudy of vancomycin and heparin observed thatvancomycin remained bactericidal against S.epidermidis but not against S. aureus.4

Another study was conducted to determine ifthe antibiotics in combination with heparinmaintained their efficacy over the course of tendays. The antibiotics used were vancomycin,cefazolin, ceftazidime, ticarcillin/clavulanicacid and ciprofloxacin independently combinedwith heparin. All the antibiotics except cef-tazidime lost less than ten percent of theiractivity in those ten days. Ceftazidime lostapproximately thirty percent of its activityafter seven days and by day ten it had onlyretained approximately fifty percent of its orig-inal activity.6

Antibiotic lock technique has not only beentested for the treatment of catheter-relatedinfections, but also for the prevention of suchinfections. Multiple in vivo studies have beenconducted with various dwell times of differentantibiotics every one to two days. These studieshave shown that antibiotic lock can


Antibiotic Lock TechniqueSubmitted by: Jennifer Judges

Pharmacy Student for Carolee Awde-Sadler Peterborough Regional Hospital, Peterborough Ontario

successfully prevent catheter colonization andis able to prevent catheter infections.7-11 Themost effective combination is vancomycin25mcg/ml with heparin 9.75u/ml to preventgram positive bacteria and the addition ofciprofloxacin 2mcg/ml if gram negative cover-age is also desired.1 The issue with preventa-tive therapy is the risk of resistance to theantibiotics developing. With continued usethere is the risk that the bacteria will be able toadapt to the antibiotic’s effects and will nolonger be susceptible and if resistant bacteriaare already present in low concentration theelimination of all other bacteria will allow theresistant ones to flourish. This is particularly anissue with methacillin resistant S. aureusbecoming resistant to vancomycin. However,the risk of resistance developing with theantibiotic lock technique appears to be lowerthan the use of systemic antibiotics or flushsolutions used as preventative therapy.1

Overall, the evidence is in support of the effica-cy of antibiotic lock technique and it has beenproven to be effective monotherapy for treat-ing catheter-related infections and as suchextending the life of the catheter. This tech-nique will be less effective if the infection hasprogressed into septicemia or if the tunnel orinsertion site has become infected. Despite thatmany studies have been conducted on the sub-ject of antibiotic lock technique dwell timesand frequency of antibiotic locks is not wellestablished. Thus far the studies conductedhave been small and used various antibiotics,dwell times and frequency of administration. Inorder to determine a standardized regimen forantibiotic lock, large randomized trials need tobe conducted in order to determine the mostappropriate antibiotic, its dose, frequency ofadministration, duration of dwell, length oftherapy and the role of systemic antibiotics inconjunction with the antibiotic lock technique.At this point antibiotic lock technique is aviable option for the treatment of catheter-related infections and should certainly be con-sidered in patients where salvaging venousaccess is a high priority, but the particular dos-ing details remain at the discretion of the pre-scribing physician.1

References:1. Bestul M, VandenBussche H. Antibiotic lock technique:Review of the Literature. Pharmacotherapy. 2005;25(2):211-2272. Messing B, Peitra-Cohen S, Debure A, Bernier JJ.Antibiotic-lock technique: A new approach to optimaltherapy for catheter-related sepsis during home-par-enteral nutrition patients. Journal of Parenteral andEnteral Nutrition 1998; 12:185-1893. Andris DA, Krzywda EA, Edmiston CE, Krepel CJ, GohrCM. Elimination of intraluminal colonization by antibi-otic lock in silicone vascular catheters. Nutrition1998;14:427-324. Henrickson KJ, Powell KR, Schwartz CL. A dilute solu-tion of vancomycin and heparin retains antibacterialand anticoagulant activities. Journal of InfectiousDisease 1988;157:600-1.5. Henrickson KJ, Dunne WM. Modification of centralvenous catheter flush solution improves in vitro antimi-crobial activity. Journal of Infectious Disease 1992;166:544-6.6. Anthony TU, Rubin LG. Stability of antibiotics used forantibiotic-lock treatment of infections of implantablevenous devices (ports). Antimicrobial Agents andChemotherapy 1999;43:2074-6.7. Schwartz C, Henrickson KJ, Roghmann K, Powell K.Prevention of bacteremia attributed to luminal colo-nization of tunneled central venous catheters with van-comycin-susceptible organisms. Journal of ClinicalOncology 1990;8:1591-7.8. Carratala J, Niubo J, Fernandez-Sevilla A, et al.Randomized, double-blind trial of an antibiotic-locktechnique for prevention of gram-positive centralvenous catheter-related infection in neutropenicpatients with cancer. Antimicrobial Agents andChemotherapy 1999;43:2200-4.9. Barriga FJ, Varas M, Potin M, et al. Efficacy of a van-comycin solution to prevent bacteremia associated withan indwelling central venous catheter in neutropenicand non-neutropenic cancer patients. Medical andPaediatric Oncology 1997;28:196-200.10. Henrickson KJ, Axtell RA, Hoover SM, et al.Prevention of central venous catheter-related infectionsand thrombotic events in immunocompromised chil-dren by the use of vancomycin/ciprofloxacin/heparinflush solution: a randomized, multicenter, double-blindtrial. Journal of Clinical Oncology 2000;18:1269-78.11. Haimi-Cohen Y, Husain N, Meenan J, Karayalcin G,Lehrer M, Rubin LG. Vancomycin and ceftazidime bioac-tivities persist for at least 2 weeks in the lumen in ports:simplifying treatment of port-associated bloodstreaminfections by using the antibiotic lock technique.Antimicrobial Agents and Chemotherapy 2001; 45:1565-7.


The International Society for Peritoneal Dialysis (ISPD) [1] con-siders the prevention of catheter infections and peritonitisthe primary goal of exit-site care. Antibacterial soap andwater are recommended by some, while others use an anti-septic to clean the exit-site. Povidone-iodine or chlorhexidinefor cleansing are reasonable options. Hydrogen peroxide isdrying and should be avoided for routine care.

Staphylococcus aureus nasal carriage is associated with anincreased risk of S. aureus exit-site infections (ESIs) and peri-tonitis. Prophylaxis using a daily application of mupirocincream or ointment to the skin around the exit-site has beeneffective in reducing S. aureus ESIs and peritonitis. Mupirocinointment, but not cream, should be avoided at the exit-site inpatients using polyurethane catheters, as this can lead tostructural damage of the catheter. Mupirocin resistance hasbeen reported, particularly with intermittent use. Resistanceto mupirocin can be classified as low if the minimal inhibito-ry concentration (MIC) is > 8 mg/mL, or high if the MIC is > 512mg/mL. Resistance to mupirocin currently does not appear tohave reduced its efficacy, but could occur in the future.

With a reduction in S. aureus using mupirocin, Pseudomonasaeruginosa becomes the most problematic organism at theexit-site. Gentamicin cream applied daily to the exit-site wasshown to be as effective as mupirocin in reducing S. aureusESIs, and highly effective in reducing P. aeruginosa ESIs andsubsequent peritonitis as well. Ciprofloxacin otologic solutionapplied daily to the exit-site was also effective in reducingboth S. aureus and P. aeruginosa compared to historic con-trols using soap and water only.

Patients with prolonged/repeated courses of antibiotics areat increased risk of fungal peritonitis, usually caused byCandida. Studies have examined the role of prophylaxis usingantifungals, such as oral nystatin or fluconazole, duringantibiotic therapy, with mixed results. Programs with highbaseline rates of fungal peritonitis found prophylaxis to bebeneficial, while those with low baseline rates did not. The CARI Guidelines [2] looked at 3 RCTs (n=371) and 2prospective historically-controlled studies (n=472). Two of theRCTs assessed the use of intranasal mupirocin treatment toprevent ESIs and peritonitis. One study evaluated mupirocinointment compared with placebo, while the other comparedmupirocin with neomycin sulphate nasal ointment. Therewas a statistically significant reduction in the rate of ESIs dueto S. aureus in both studies. The third RCT compared topicalmupirocin with oral rifampin to prevent ESI and peritonitis,and found that there was no difference between the groupsin the rate of ESI or peritonitis due to S. aureus.

One of the non-randomized studies involved the daily appli-cation of mupirocin cream to the exit-site for 11 months, and

it was found this group had reductions in the rate of ESI andperitonitis. The other non-randomized trial evaluated theeffectiveness of mupirocin cream at the exit-site daily for 1year. It was reported that the daily application of mupirocincream significantly reduced the incidence of ESIs due to S.aureus and peritonitis, and that there was no mupirocinresistance was found after 1 year of use.

In summary, CARI recommends prophylactic therapy usingmupirocin ointment intranasally, especially for S. aureus car-riage, to decrease the risk of S. aureus catheter ESIs and peri-tonitis. Based on lower levels of evidence, they also suggestprophylactic therapy using mupirocin ointment at the exit-site, and to avoid long-term daily use of mupirocin (especial-ly for more than 4 years).

The results of the Joanna Briggs Institute review [3] did notfind that any one antibiotic or antiseptic to be better thananother for the prevention of ESI rates or peritonitis. Thereare large gaps in the existing knowledge regarding the careof exit-sites in PD patients, and further research using long-term RCTs with sufficient power and blinding is needed. Untilbetter evidence is available, practice will continue to rely pri-marily on the experience of the clinician. However, the fol-lowing recommendations may be helpful: Prophylactic thera-py using mupirocin ointment at the exit-site may decreasethe risk of S. aureus ESI; Povidone-iodine applied to the exit-site may be effective in reducing the rate of ESIs up to 140days after start of PD, after which the effectiveness of thistreatment becomes less clear; A silver ring placed around thecatheter at the exit-site is not recommended for the preven-tion or reduction in ESIs or peritonitis.

The Cochrane Collaboration [4] did a combined search ofMEDLINE, EMBASE, and the specialist registry of theCochrane Renal Group identified 19 eligible trials for review,totaling 1949 patients. The quality of the trials was variablesince information on blinding, randomization, and the use ofintention-to-treat analysis were not always provided. Therewere insufficient data to evaluate the comparative effects ofthe different antimicrobial agents in head-to-head trials

The review concluded that prophylactic strategies, such asprophylactic oral antibiotics (co-trimoxazole, cephalexin,ofloxacin or rifampin) and topical disinfectants (povidone-iodine), have not been shown to be effective compared tostandard care in reducing the risk of ESIs or peritonitis. Theexception is that the eradication of nasal S. aureus carriagewith topical mupirocin effectively decreases the risk of exit-site, but not peritonitis. Also, one trial found that concomi-tant oral nystatin with antibiotic therapy may reduce theoccurrence of Candida peritonitis.


DI PD Exit SiteWhat substances can be used to prevent infections of the peritoneal dialysis catheter exit-site?Submitted by:Chung-Yi Ling

Pharmacy Student


Table 1 below summarizes the ODB coverage status of the substances mentioned above.

Name DIN Brand, Strength, Form

Maker Drug Benefit Price

Amount MOHLTC Pays

Inter-changeable

Limited Use

00158348 Betadine 10% top soln

PFP N/A N/A Yes No

00172944 Poviodine 10% top soln

ROG N/A N/A Yes No

Chlorhexidine02239757 Bactroban 2%

crGSK 0.5182 0.5182 No No

01916947 Bactroban 2% oint

GSK 0.5182 0.3556 Yes No

02279983 Taro-mupirocin 2% oint

TAR 0.3556 0.3556 Yes No

Gentamicin 00028339 Garamycin 0.3% opth oint

SCH 4.000 4.000 No No

Ciprofloxacin00029416 Mycostatin 500

000U tabBQU N/A N/A Yes No

02194198 Ratio-Nystatin 500 000U tab

RPH 0.1680 0.1680 Yes No

APX, GEN, NOP, PMSPFI

APX, COB, GEN, NOP, PMS, TARPFI

APX, COB, GEN, NOP, PMS, TARPFI

Yes Yes

Yes Yes

Fluconaozle 100mg tab

Yes Yes

Nystatin

Fluconazole Many Fluconazole 150mg cap

Fluconazole 50mg tab

Povidone-Iodine

Not in FormularyMupirocin

Not in Formulary

4.4020

7.290015.163

9.1562

4.4020

7.2900

2.4814

5.1614

2.4814

References:

1) International Society for Peritoneal Dialysis. Peritoneal Dialysis-Related Infections Recommendations: 2005Update. Peritoneal Dialysis International. 2005:25;107-31.

2) Caring for Australians with Renal Impairment. The CARI Guidelines – Prophylaxis for exit site/tunnel infectionsusing mupirocin. 2004. [cited January 2008] Available: URL:http://www.cari.org.au/Part_4_12_Exit_site_tunnel_infection_140904.pdf

3) The Joanna Briggs Institute. Clinical effectiveness of different approaches to peritoneal dialysis catheter exit-site care. Best Practice. 2004:8(1);1-7. ISSN 1329 – 1874.

4) Strippoli GFM, Tong A, Johnson D, Schena FP, Craig JC. Antimicrobial agents for preventing peritonitis in peri-toneal dialysis patients. Cochrane Database of Systematic Reviews. 2004, Issue 4. Art. No.: CD004679. DOI:10.1002/14651858.CD004679.pub2

5) Ontario Ministry of Health. Formulary Search. 2007 [cited February 2008] Available: URL: https://www.health-info.moh.gov.on.ca/formulary/


Final Abx in PD SolutionsThe Stability of Common Antibiotics Used to Treat Peritonitis in Various Heparinized and Non-Heparinized Peritoneal Dialysis Solutions Submitted by: Jennifer Judges

Pharmacy Student for Carolee Awde-Sadler Peterborough Regional Hospital, Peterborough Ontario

Antibiotic Icodextrin Dextrose Nutrineal Heparin Compatibility Tobramycin Stable for 24

hours at 25°C and then an additional 4 hours at 37°C 8

1.5% dextrose: Stable for less than 24 hours at 25°C 8

Stable for 24 hours at 25°C and then an additional 4 hours at 37°C 8

Stable for 48 hours at 25°C 6

Vancomycin Stable for 7 days at 4°C or 25°C 4 Stable for 24 hours at 37°C 4 Stable for 24 hours at 25°C and then an additional 4 hours at 37°C 8

1.5% dextrose: Stable for 24 hours at 25°C and then an additional 4 hours at 37°C 8

Stable for 5 to 6 days at 4°C or 25°C or 37°C 7

4.25% dextrose: Stable for 5 to 6 days at 4°C or 25°C or 37°C 7


1.5% dextrose: Stable for 5 to 6 days at 4°C or 25°C or 37°C 7 Icodextrin: Stable for 48 hours at 25°C 1

Cefazolin Stable for 30 days at 4°C or 25°C 2 Stable for 48 hours at 37°C 5


1.5% dextrose: Stable for 20 days at 4°C Stable for 11 days at 25°C 9 Stable for 60 hours at 37°C 5


2.5% dextrose: Stable for 60 hours at 37°C 5

4.25% dextrose: Stable for 60 hours at 37°C 5


1.5% dextrose: Stable for 20 days at 4°C Stable for 11 days at 25°C 9

1.5% / 2.5% / 4.25% dextrose: For 125mg/L: Stable for 60 hours at 37°C For 500mg/L: Stable for 48 hours at 37°C5 Icodextrin: For 125mg/L: Stable for 48 hours at 37°C For 500mg/L: NOT STABLE 5

Ceftazidime Stable for 48 hours at 25°C 1

1.5% dextrose: Stable for 6 days at 4°C Stable for 4 days at 25°C Stable for 12 hours at 37°C 7 Stable for 24 hours at 25°C and then an additional 2 hours at 37°C

Stable for 7 days at 4°C and then an additional 16 hours at 25°C and then an additional 8 hours at 37°C3

NO AVAILABLE DATA

1.5% dextrose: Stable for 6 days at 4°C with heparin Stable for 4 days at 25°C Stable for 12 hours at 37°C 7

References:

1. Gokal R, Moberly J, Lindholm B, Mujais S. Metabolic and laboratory effects of icodextrin. KidneyInternational 2002; 62: S62-S71

2. Li YF, Wu CC, Lin SH, Wang DP, Wang CN. Stability of cefazolin sodium in icodextrin-containing peri-toneal dialysis solution. American Journal of Health-System Pharmacy 2002; 59(23): 2362-2364

3. Manduru M, Fariello A, White RL, Fox JL, Bosso JA. Stability of ceftazidime sodium and teicoplanin sodium in peritoneal dialysis solution. American Journal of Health-System Pharmacy 1996; 53(22): 2731-2734

4. Nornoo AO, Elwell RJ. Stability of vancomycin in icodextrin dialysis solution. The Annals ofPharmacotherapy 2006; 40(11): 1950-1954

5. Robinson RF, Morosco RS, Smith CV, Mahan JD. Stability of cefazolin sodium in four heparinized andnon-heparinized dialysate solutions at 38 degrees Celsius. Peritoneal Dialysis International 2006; 26(5): 593-597

6. Sewell DL, Golper TA, Brown SD, Nelson E, Knower M, Kimbrough RC. Stability of single and combina-tion antimicrobial agents in various peritoneal dialysates in the presence of insulin and heparin. AmericanJournal of Kidney Disease 1983; 3(3): 209-212

7. Vaugh LM, Poon CY. Stability of ceftazidime and vancomycin alone and in combination in heparinizedand nonheparinized peritoneal dialysis solution. The Annals of Pharmacotherapy 1994; 28:572-575

8. Voges M, Faict G, Lechine G, Taminne M. stability of drug additives in peritoneal dialysis solutions in anew container. Peritoneal Dialysis International 2004; 24(6): 590-595

9. Wu CC, Wang DP, Wong CY, Lin YF. Stability of cefazolin in heparinized and nonheparinized peritonealdialysis solutions. American Journal of Health-System Pharmacy 2002; 59(16): 1537-1538


Karen Shalanskyobtained herB.Sc.(Pharm) at theUniversity ofToronto and herPharm.D. degree atthe MedicalUniversity of SouthCarolina in 1990,where she graduat-ed top of her class.She has been a

Pharmacotherapeutic Specialist in nephrology atVancouver General Hospital (VGH) since 1996.Specifically, Karen follows the VGH hemodialysisunit patients, where she performs semi-annual med-ication reviews, follows and interprets all regularlyscheduled laboratory tests, attends daily patient-care rounds and provides administrative support tothe unit. Karen has also been the acting clinicalcoordinator for the past 2 years, and is the editor of

the VGH Parenteral Drug Therapy Manual,Formulary, and Drugs & Therapeutics Newsletter.

Karen’s pastimes include reading, watching movieson the big screen, skiing, and traveling with her hus-band Steve and two children – Rebecca (15) andBenjamin (12). She also loves to shop, and at therecent 2008 spring RPN conference in Toronto,Karen was coaxed (by fashion aficionado JoanneJung) into buying an expensive pair of Fidelity jeans.She lives in these jeans and now realizes that it’s allabout “cost per wear”.

Along with her co-chair elect, Joanne Jung, Karenhopes to broaden the awareness of the RPN inWestern Canada. Joanne and Karen are excited tohost the first western RPN dinner conference inVancouver on Wed Nov 5 (see information in thisissue).

Member ProfileKaren Shalansky


RPN - Western Conference

www.Nephrorx.com

A new website developed and maintained by oneof our members, Lisa Sever.

The website contains links to abstracts and articlesfor treating symptoms and complications of kid-ney disease. There are also sections which link torenal clinical practice guidelines, for dosing/dialyz-ability of drugs references and to important infor-mation for developing or updating medication-related protocols for your dialysis units.

Whether you are a new renal pharmacist, teachinga pharmacy intern or resident, or a generalist with

an interest in renal disease and pharmacotherapy–this website will reduce the time spent searching for “key” articles – thus allowing you more time tolearn/teach effectively.

Check it out – many of the links/articles are fromRPN members. Sign up for the e-mail updates (youwon’t be bombarded with e-mails – only impor-tant information, once or twice a month). Lisa islooking for feedback and suggestions on type ofinformation and look and feel of the website. Youcan forward feedback to her at [email protected]


Website of Interest

Please refer to www.nephrologynow.com forthe most current articles of interest

A r t i c l e s o f I n t e r e s t

American Society of NephrologyRenal Week 2008

November 4-9, 2008Philidelphia. PA, USA

RPN CE EventOctober 30, 2008

Toronto, ON

U p c o m i n g C o n f e r e n c e s


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SS pp oo nn ss oo rr ssThe Renal Pharmacists Network would like to thank the following sponsors for their

continued support and generous contributions.

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