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Following the market authorization of the first insulin biosimilar in 2014, further approvals are to be expected due to patent expiry of several originator insulins. Knowledge of the manufacturing and the characteristics of these pharmaceutical products is important for their rationale and safe use by the physician, the pharmacist and the patient.Biosimilars are not generics, but similar or comparable, yet not identical versions of the originator biopharmaceutical. Marketing authorization in the EU is granted only after passing a stringent procedure. So far, there is no evidence of problems specifically associated with insulin biosimilars. However, shifting a patient from an originator insulin to a biosimilar (or vice versa) should be done with care and under close monitoring. Automatic substitution of biosimilars in the pharmacy is not permitted in Germany. Administration devices also have a significant impact on safe use., (© Georg Thieme Verlag KG Stuttgart · New York.)

Extensive Catabolism is a hallmark of patients with acute renal failure (ARF) complicating critical illnesses. Catabolism is due to dysregulation of protein metabolism as well as a consequence of diminished renal excretion and renal replacement therapy (RRT). Inadequate nutritional support predisposes patients to malnutrition and increased mortality risk. Since the catabolic rate varies widely in ARF patients and can not be predicted by clinical parameters, direct quantification of the protein catabolic rate should be performed regularly. The urea nitrogen appearance rate (UNA) is a valid and reproducible estimate of nitrogen balance in critically ill patients undergoing continuous RRT. Amino acid losses up to 50 g/day and protein losses up to 15 g/day occur during continuous RRT and need to be compensated for. In order to achieve neutral or positive nitrogen balance a nutritional regimen providing 1.5-2.0 g protein/kg/day and 25-35 kcal/kg/day may be required. Since glutamine losses during continuous RRT may exceed 4 g/day, glutamine supplementation (0.3-0.5 g/kg/day) appears to be recommendable.

Background: Malnutrition in hemodialysis patient is associated with increased mortality and morbidity. Inventions to treat malnutrition are often ineffective. Underestimation by the patients of the importance of dietary interventions might negatively influence any therapeutic outcome. We examined the correlation between nutritional assessment by the patient himself and clinical assessment by the physician., Patients and Methods: Subjective global assessment (SGA) was performed in 68 chronic hemodialysis patients Serum concentrations of albumin, prealbumin, transferrin and cholesterin were measured Protein intake was estimated by protein catabolic rate (nPCR). In form of a questionnaire patients were asked to assess then own nutrition., Results: According to SGA-criteria, moderate to severe malnutrition was found in 34% of our patients. In this unauthorized group serum albumin was < 4.0 g/dl in 45% of patients and correlated best with clinical nutritional assessment. Specificity was lower for prealbumin, transferrin, cholesterin, and nPCR. The questionnaire was completed by 85% of patients. Self-assessment of their own nutrition was discrepant to clinical assessment in 84% of malnourished patients. A similar percentage (79%) of malnourished patients considered their own body weight to be adequate, while only 21% indicated desire to gain weight., Conclusions: Our data indicate that a significant percentage of malnourished hemodialysis patients shows a tendency to overestimate their own nutrition. This may negatively influence patient compliance and should be considered in dietary counseling of malnourished chronic hemodialysis patients.