Knehtl Maša, Petreski Tadej, Piko Nejc, Ekart Robert, Bevc Sebastjan
Department of Nephrology, University Medical Center Maribor, Maribor, Slovenia.
Faculty of Medicine, University of Maribor, Maribor, Slovenia.
Front Psychiatry. 2022 May 12;13:882860. doi: 10.3389/fpsyt.2022.882860. eCollection 2022.
Hemodialysis (HD) is the most common method of chronic kidney failure (CKF) treatment, with 65% of European patients with CKF receiving HD in 2018. Regular two to three HD sessions weekly severely lower their quality of life, resulting in a higher incidence of depression and anxiety, which is present in one third to one half of these patients. Additionally, the age of patients receiving HD is increasing with better treatment and care, resulting in more cognitive impairment being uncovered. Lastly, patients with other mental health issues can also develop CKF during their life with need for kidney replacement therapy (KRT). All these conditions need to receive adequate care, which often means prescribing psychotropic medications. Importantly, many of these drugs are eliminated through the kidneys, which results in altered pharmacokinetics when patients receive KRT. This narrative review will focus on common issues and medications of CKF patients, their comorbidities, mental health issues, use of psychotropic medications and their altered pharmacokinetics when used in HD, polypharmacy, and drug interactions, as well as deprescribing algorithms developed for these patients.
血液透析（HD）是慢性肾衰竭（CKF）最常见的治疗方法，2018年欧洲65%的CKF患者接受了血液透析。每周定期进行两到三次血液透析会严重降低他们的生活质量，导致抑郁和焦虑的发生率更高，这些患者中有三分之一到一半存在此类情况。此外，随着治疗和护理水平的提高，接受血液透析的患者年龄在增加，导致更多的认知障碍被发现。最后，患有其他心理健康问题的患者在其一生中也可能发展为CKF，需要进行肾脏替代治疗（KRT）。所有这些情况都需要得到充分的护理，这通常意味着开具精神药物。重要的是，这些药物中的许多是通过肾脏排泄的，这导致患者接受KRT时药代动力学发生改变。本叙述性综述将重点关注CKF患者的常见问题和药物、他们的合并症、心理健康问题、精神药物的使用及其在血液透析中使用时改变的药代动力学、多重用药和药物相互作用，以及为这些患者制定的减药算法。
