Janus Nicolas, Launay-Vacher Vincent
Service ICAR, Nephrology Department, Pitié-Salpêtrière Hospital, Paris, France.
Semin Dial. 2015 Jul-Aug;28(4):413-6. doi: 10.1111/sdi.12371. Epub 2015 Apr 11.
The increased incidence of malignancies in patients with chronic kidney patients and especially in end-stage kidney disease (ESKD) patients has been discussed since the mid-1970s. Consequently, oncologists, nephrologists, and pharmacists are increasingly facing challenging situations of cytotoxic drug handling in dialysis patients because of pharmacokinetic modifications. In these patients, two main issues must be considered. First, the absence of renal function in hemodialysis (HD) patients may necessitate drug dosage reduction. Therefore, drug prescription must be cautiously checked before administration with appropriate dosage adjustment whenever necessary to ensure efficacy while avoiding overdosage and related side effects. Second, drug clearance by dialysis session must be taken into account for appropriate chemotherapy timing administration to avoid drug removal, which may result in a loss of efficacy. These two main considerations must not be considered as a contra-indication to chemotherapy in ESKD patients, but more as a need for an individualized prescription according to available recommendations.
自20世纪70年代中期以来，慢性肾脏病患者尤其是终末期肾病（ESKD）患者恶性肿瘤发病率的增加一直备受讨论。因此，由于药代动力学改变，肿瘤学家、肾病学家和药剂师在透析患者中处理细胞毒性药物时面临的挑战日益增多。对于这些患者，必须考虑两个主要问题。首先，血液透析（HD）患者缺乏肾功能可能需要减少药物剂量。因此，在给药前必须谨慎检查药物处方，并在必要时进行适当的剂量调整，以确保疗效，同时避免过量用药及相关副作用。其次，在进行适当的化疗时间给药时，必须考虑透析过程中的药物清除情况，以避免药物被清除，这可能导致疗效丧失。这两个主要考虑因素不应被视为ESKD患者化疗的禁忌症，而更应被视为需要根据现有建议进行个体化处方。
