Stefani Maurizio, Singer Richard F, Roberts Darren M
Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney.
St Vincent's Clinical School, University of New South Wales, Sydney.
Aust Prescr. 2019 Oct;42(5):163-167. doi: 10.18773/austprescr.2019.054. Epub 2019 Oct 1.
Drugs excreted by the kidney require dose reduction in chronic kidney disease. This adjustment depends on the severity of the disease and what proportion of the drug is eliminated by the kidneys The estimated glomerular filtration rate can generally be used to guide dose adjustment in patients with stable kidney function. However, the formula can be misleading in some patient subsets and other approaches are required At extremes of body mass, the estimated glomerular filtration rate can under- or overestimate kidney function. It may need to be adjusted for body surface area, particularly for drugs with a narrow therapeutic range or requiring a minimum concentration to be effective. Close monitoring of drug effect and toxicity is also needed and can be supported by therapeutic drug monitoring For short courses of drugs with a wide therapeutic index, dose adjustment may not be needed Alternative methods for quantifying kidney function include the Cockcroft-Gault formula (estimates creatinine clearance) or direct measures of glomerular filtration rate using exogenous isotope compounds. These are not commonly required
经肾脏排泄的药物在慢性肾脏病患者中需要减少剂量。这种调整取决于疾病的严重程度以及药物经肾脏清除的比例。估计肾小球滤过率通常可用于指导肾功能稳定患者的剂量调整。然而，该公式在某些患者亚组中可能会产生误导，需要采用其他方法。在体重极端情况下，估计肾小球滤过率可能会低估或高估肾功能。可能需要根据体表面积进行调整，特别是对于治疗窗窄或需要最低浓度才能起效的药物。还需要密切监测药物疗效和毒性，并可通过治疗药物监测提供支持。对于治疗指数宽的药物短期疗程，可能不需要调整剂量。量化肾功能的替代方法包括Cockcroft-Gault公式（估计肌酐清除率）或使用外源性同位素化合物直接测量肾小球滤过率。通常不需要这些方法
