Doogue Matthew P, Polasek Thomas M
Department of Clinical Pharmacology, Flinders University.
Clin Biochem Rev. 2011 May;32(2):69-73.
Renal disease alters the effects of many drugs, particularly when active drug moieties are renally cleared. Drug doses should usually be reduced in renal disease in proportion to the predicted reduction in clearance of the active drug moiety. Patient factors to consider in adjusting drug doses include the degree of renal impairment and patient size. Drug factors to consider in adjusting doses include the fraction of the drug excreted unchanged in urine and the drug's therapeutic index. Estimates of renal function are useful to guide dosing of renally cleared drugs with medium therapeutic indices, but are not precise enough to guide dosing of drugs with narrow therapeutic indices. This article discusses principles of drug dose adjustment in renal disease.
肾脏疾病会改变许多药物的作用，尤其是当活性药物部分通过肾脏清除时。在肾脏疾病中，药物剂量通常应根据活性药物部分清除率的预计降低幅度相应减少。调整药物剂量时应考虑的患者因素包括肾功能损害程度和患者体型。调整剂量时应考虑的药物因素包括药物以原形经尿液排泄的比例和药物的治疗指数。肾功能评估有助于指导治疗指数中等的经肾脏清除药物的给药，但不够精确，无法指导治疗指数窄的药物给药。本文讨论了肾脏疾病中药物剂量调整的原则。
