Turnheim K
Abteilung für Pharmakokinetik, Pharmakologisches Institut der Universität, Vienna, Austria.
Eur J Clin Pharmacol. 1991;40(1):87-93. doi: 10.1007/BF00315145.
As the renal elimination of most drugs is closely correlated with the endogenous creatinine clearance, it is possible to use this parameter of kidney function to adjust drug dosage in renal failure. However, this simple procedure neglects possible changes in the volume of distribution, plasma protein binding, drug metabolism, intestinal absorption, and pharmacodynamics in renal insufficiency, as well as the occurrence of biologically active drug metabolites. Because of these uncertainties in critical cases the validity of the dosage calculated using the creatinine clearance should be checked by clinical surveillance and measurements of drug blood concentrations. Further, pharmacokinetic dosage guidelines based on the individual creatinine clearance may not be applicable to diuretics and drugs which have markedly differing kinetics of pharmacodynamic effects and blood levels.
由于大多数药物的肾脏清除率与内源性肌酐清除率密切相关，因此可以使用这个肾功能参数来调整肾衰竭患者的药物剂量。然而，这个简单的方法忽略了肾功能不全时药物分布容积、血浆蛋白结合、药物代谢、肠道吸收和药效学可能发生的变化，以及生物活性药物代谢产物的出现。由于这些关键情况下的不确定性，在临床监测和药物血药浓度测量时，应检查使用肌酐清除率计算的剂量的有效性。此外，基于个体肌酐清除率的药代动力学剂量指南可能不适用于利尿剂和药效学作用和血药水平动力学明显不同的药物。
