Evoh Onyinyechi V, Chatterjee Totini, O'Mahony Sean, Raji Mukaila
Department of Internal Medicine, Division of Palliative Care, University of Texas Medical Branch at Galveston, Galveston, USA.
Department of Internal Medicine, Division of Geriatrics, University of Texas Medical Branch at Galveston, Galveston, USA.
Cureus. 2024 Oct 14;16(10):e71439. doi: 10.7759/cureus.71439. eCollection 2024 Oct.
Patients with end-stage renal disease (ESRD), especially those on dialysis, experience myriad medical and psychological symptoms that impact theirquality of life. These symptoms range from nausea, emesis, and insomnia to pruritus, anxiety, depression, and loss of appetite. These symptoms often require multiple medications (e.g., anticholinergics, antihistamines, tricyclics, benzodiazepines, and Z-drugs), which can lead to polypharmacy, medication non-adherence, and potentially harmful drug-drug interactions, especially in older ESRD patients, a population with an age-related decline in drug metabolism, multimorbidity, and polypharmacy. The current perspective article will discuss evidence from extant literature supporting mirtazapine (a noradrenergic antagonist and selective serotonin antagonist, NASSA) as a potentially useful one-stop pharmacologic agent to alleviate multiple symptoms that ESRD patients face. A one-stop strategy has the potential to decrease polypharmacy, reduce adverse drug-drug and drug-disease interactions, reduce healthcare costs, and improve the quality of life in ESRD patients. Mirtazapine use in an ESRD setting merits a large randomized pragmatic double-blinded controlled trial to evaluate its efficacy as a potential pharmacotherapeutic agent for the management of multiple disabling gastrointestinal and other neuropsychological symptoms in older adults living with ESRD.
终末期肾病（ESRD）患者，尤其是接受透析治疗的患者，会经历无数影响其生活质量的医学和心理症状。这些症状包括恶心、呕吐、失眠，以及瘙痒、焦虑、抑郁和食欲不振等。这些症状通常需要多种药物治疗（如抗胆碱能药、抗组胺药、三环类药物、苯二氮䓬类药物和Z类药物），这可能导致用药过量、药物治疗依从性差以及潜在的有害药物相互作用，尤其是在老年ESRD患者中，这一人群存在与年龄相关的药物代谢下降、多种疾病并存和用药过量问题。本篇观点文章将讨论现有文献中的证据，支持米氮平（一种去甲肾上腺素能拮抗剂和选择性5-羟色胺拮抗剂，NASSA）作为一种潜在有用的一站式药物，可缓解ESRD患者面临的多种症状。一站式策略有可能减少用药过量、减少不良药物相互作用和药物-疾病相互作用、降低医疗成本，并改善ESRD患者的生活质量。在ESRD患者中使用米氮平值得进行一项大型随机实用双盲对照试验，以评估其作为一种潜在药物治疗剂，用于管理老年ESRD患者多种致残性胃肠道和其他神经心理症状的疗效。
