癌症药物在慢性肾脏病和透析中的剂量调整。

Cancer Drug Dosing in Chronic Kidney Disease and Dialysis.

机构信息

Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut, USA.

Department of Microbiology, Immunology and Transplantation, Laboratory of Molecular Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium; Division of Nephrology, University Hospitals Leuven, Leuven, Belgium.

出版信息

Adv Chronic Kidney Dis. 2022 Mar;29(2):208-216.e1. doi: 10.1053/j.ackd.2021.12.002.

DOI:10.1053/j.ackd.2021.12.002

PMID:35817528

Abstract

Patients with malignancies have a high prevalence of kidney disease and are often treated with antineoplastic agents that undergo kidney metabolism or excretion or clearance via renal replacement therapies. Thus, the dosing of these agents, including classic chemotherapeutic drugs, targeted therapies, and immunotherapy, must take into account patients' kidney function. In this review, we will discuss the pitfalls of accurate measurement of kidney function and how kidney disease affects both pharmacodynamic and pharmacokinetic properties of drugs. Lastly, we will discuss specific agents and summarize current dosing strategies for use in patients with chronic kidney disease and end-stage kidney disease.

摘要

患有恶性肿瘤的患者中肾脏疾病的患病率很高，并且经常使用经历肾脏代谢或排泄或通过肾脏替代疗法清除的抗肿瘤药物进行治疗。因此，这些药物（包括经典化疗药物、靶向治疗药物和免疫治疗药物）的剂量必须考虑到患者的肾功能。在这篇综述中，我们将讨论准确测量肾功能的难点以及肾脏疾病如何影响药物的药效学和药代动力学特性。最后，我们将讨论特定的药物，并总结目前在慢性肾脏病和终末期肾脏病患者中的用药策略。