Erdélyi Lóránd, Trásy Domonkos
Faculty of Helath and Sport Science, Széchenyi István University, 9026 Győr, Hungary.
Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary.
Pharmaceuticals (Basel). 2024 Nov 22;17(12):1571. doi: 10.3390/ph17121571.
The physiology of the kidney has long been understood, and its mechanisms are well described. The pathology of renal failure is also a deeply researched area. It seems logical, therefore, to create devices that can replace the lost normal function of the kidney. Using the physical processes that take place in the kidney, such as diffusion or convection across a membrane, various renal replacement therapies (RRT) have been created. There are those that are used intermittently and those that are used for longer periods. What they have in common is that all RRTs have the same purpose; to replace the excretory function of the kidney that has been lost. CRRT is an extracorporeal renal replacement therapy that effectively replicates the excretory function of the kidneys in cases of acute renal failure. However, it has become increasingly evident that this rapidly advancing treatment modality offers benefits beyond merely substituting kidney function, with its applications continuing to expand significantly with non-renal and other indications. The use of these devices has raised new questions, many of which are still not clearly answered. When should this start? Who should receive it? How long should it last? What indication should it be for? What modality should it be with? How does it change the pharmacokinetics of the medicines? To answer these questions, it is first worth understanding the mechanisms behind the processes and the factors that influence them. This should not only focus on the procedures used in RRT therapies, but also consider the patient's condition and the physicochemical properties of the drugs. In this review, we aim to provide a literature summary to highlight the factors that may influence the success of RRT therapies.
肾脏的生理学早已为人所熟知，其机制也有详尽描述。肾衰竭的病理学也是一个深入研究的领域。因此，制造能够替代肾脏丧失的正常功能的装置似乎是合乎逻辑的。利用肾脏中发生的物理过程，如跨膜扩散或对流，人们创造了各种肾脏替代疗法（RRT）。有间歇性使用的，也有长期使用的。它们的共同之处在于，所有RRT都有相同的目的；替代已丧失的肾脏排泄功能。连续性肾脏替代治疗（CRRT）是一种体外肾脏替代疗法，在急性肾衰竭病例中能有效复制肾脏的排泄功能。然而，越来越明显的是，这种迅速发展的治疗方式所带来的益处不仅仅是替代肾脏功能，其应用在非肾脏及其他适应症方面也在持续大幅扩展。这些装置的使用引发了新的问题，其中许多问题仍未得到明确解答。何时开始治疗？谁应该接受治疗？治疗应持续多长时间？适应症是什么？采用何种方式？它如何改变药物的药代动力学？为了回答这些问题，首先值得了解这些过程背后的机制以及影响它们的因素。这不仅应关注RRT治疗中使用的程序，还应考虑患者的病情以及药物的物理化学性质。在本综述中，我们旨在提供一份文献总结，以突出可能影响RRT治疗成功的因素。
