通过脏排出的药物使用的挑战:评估囊素C和血清肌素eGFR异调
Brandy N Hernandez1, Patrick M Wieruszewski1,2, Jason N Barreto1
1Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA.
Pharmacotherapy
|November 27, 2024
概括
使用血清囊素C (CysC) 估计功能,与住院患者的血清肌素相比,显示出显著的差异. 这种功能失调影响了许多通过排泄的药物的剂量,突出了关键的患者安全问题.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 临床药理学 临床药理学
- 生物标志物研究 生物标志物研究
背景情况:
- 准确估计淋巴膜过率 (GFR) 对于住院患者的药物剂量至关重要.
- 血清肌素 (Cr) 对GFR估计有局限性,这促使人们探索血清囊素C (CysC) 作为替代生物标志物.
- 这项研究调查了基于肌素 (eGFRCr) 和囊素C (eGFRCysC) 的估计GFR与大量住院患者队列之间的差异.
研究的目的:
- 在住院患者中评估eGFRCr和eGFRCysC之间的不一致程度.
- 为了确定受这种eGFR异常影响的通过排泄的药物的频率.
- 评估GFR估计差异对药物管理的临床影响.
主要方法:
- 一项多站点历史研究分析了2011年至2023年间住院成人的数据.
- 在24小时内同时测量血清肌素和CysC,用于分析.
- 描述和量化了eGFR异常和通过排泄的药物的使用.
主要成果:
- 包括17,718名患者,其EGFRCr中位数为65mL/min,EGFRCysC中位数为46mL/min.
- 45%的患者表现出eGFRCr和eGFRCysC之间的绝对差异>30%.
- 显著更高的比例的患者有eGFR<30毫升/分钟的eGFRCysC (26%) 与eGFRCr (15%).
- 患者被处方了许多药物,其中39%±13%通过脏排出,80%的EGFR异常患者接受了≥5种通过脏排出的药物.
结论:
- 在住院患者中,eGFRCysC和eGFRCr之间存在显著的不一致.
- 这种异常直接影响了通过排泄的药物的剂量和管理.
- 进一步的研究至关重要,以优化GFR评估不一致的患者的脏排泄药物的药物治疗,以提高安全性和疗效.
相关概念视频
01:17Factors Affecting Renal Clearance: Renal Impairment
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Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
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01:08Renal Drug Clearance: Comparison Between Renal Excretion Methods
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Renal clearance is a critical parameter encompassing kidney filtration, secretion, and reabsorption processes. It is calculated using a specific equation to determine the rate at which the kidneys clear a drug.
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01:23Renal Clearance
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The glomerular filtration rate (GFR) is a critical marker of kidney function, reflecting the efficiency of filtration by the glomeruli. Renal clearance of specific substances, such as inulin or creatinine, is commonly used to measure GFR.
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01:11Renal Failure: Dose Adjustments
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In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
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01:06Renal Drug Clearance: Overview
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135