Fillastre J P, Singlas E
Department of Nephrology, School of Medicine, Rouen, France.
Clin Pharmacokinet. 1991 Apr;20(4):293-310. doi: 10.2165/00003088-199120040-00004.
Many drugs are eliminated via the renal route and the usual dose must be modified in patients with severe renal impairment. This review is an attempt to supply physicians with the more recent data on pharmacokinetic studies of new drugs administered in uraemic patients. The review is in 2 parts: the first indicates the results of studies on the pharmacokinetics of antibiotic agents, antifungal, antiviral and antiulcer drugs, and nonsteroidal anti-inflammatory drugs. Special mention is made of epoetin (recombinant human erythropoietin). It was not possible to give all the information collected from the recent literature: since mild renal failure has little effect on the fate of a drug, pharmacokinetic data obtained in patients with a creatinine clearance (CLCR) of more than 50 ml/min has been omitted. Both the text and tables give recommendations for treating patients with moderate renal insufficiency (CLCR of about 50 ml/min), more severe renal impairment (CLCR between 10 and 50 ml/min) and end-stage renal failure with a very low creatinine clearance (below 10 ml/min). It was not possible to give uniform recommendations (i.e. reducing the dose while maintaining the same interval, or giving the same dose and prolonging the interval). This article follows the recommendations of the authors, which may vary for drugs in similar classes.
许多药物通过肾脏途径排泄，因此重度肾功能损害患者的常用剂量必须调整。本综述旨在为医生提供有关尿毒症患者使用新药的药代动力学研究的最新数据。该综述分为两部分：第一部分指出了抗生素、抗真菌、抗病毒和抗溃疡药物以及非甾体抗炎药的药代动力学研究结果。特别提到了促红细胞生成素（重组人促红细胞生成素）。由于无法给出从近期文献中收集到的所有信息：鉴于轻度肾衰竭对药物转归影响不大，因此未列出肌酐清除率（CLCR）超过50 ml/min患者的药代动力学数据。正文和表格均针对中度肾功能不全（CLCR约为50 ml/min）、更严重肾功能损害（CLCR在10至50 ml/min之间）以及肌酐清除率极低（低于10 ml/min）的终末期肾衰竭患者给出了治疗建议。无法给出统一建议（即减少剂量同时保持相同间隔，或给予相同剂量并延长间隔）。本文遵循作者的建议，同一类药物的建议可能会有所不同。
