常规估计的膜过率报告是否会对老年人群的药物剂量产生不利影响?
Gina Davis1, Brendan Smyth2,3, Matthew Kinchington4
1Department of Renal Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia.
Internal medicine journal
|October 31, 2025
概括
在老年患者中,药物剂量错误很常见,不管是否使用估计的膜过率 (eGFR) 或肌素清除率 (eCrCl). 从Cockcroft-Gault (CG) eCrCl切换到CKD-EPI eGFR解释了一些潜在的处方错误.
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
- 老年医学 老年医学
背景情况:
- 从历史上看,Cockcroft-Gault (CG) 估计的肌素清除率 (eCrCl) 引导了功能障碍患者的药物剂量.
- 目前的标准病理学报告主要提供估计的淋巴细胞过率 (eGFR).
- eCrCl和eGFR之间的差异可能会影响老年患者的药物安全性.
研究的目的:
- 在使用eGFR与eCrCl时,调查65岁以上患者药物剂量错误的频率.
- 确定使用CKD-EPI eGFR与CG eCrCl相比是否有助于处方错误.
主要方法:
- 一个单一中心的回顾性队列研究.
- 包括162名65岁及以上的患者.
- 对超过200种需要根据GFR调整剂量的药物进行分析.
主要成果:
- 大约12.5%的药物存在潜在的处方错误,无论使用的GFR估计方法如何.
- 与CG eCrCl相比,CKD-EPI eGFR的使用仅解释了这些潜在错误的很小一部分.
- 由于该队列中eGFR和eCrCl之间的差异,没有观察到临床后果.
结论:
- 在患有脏疾病的老年患者中,潜在的药物剂量错误很普遍,无论估计方法 (eGFR或eCrCl) 是什么.
- 从CG eCrCl向CKD-EPI eGFR的转变并不是这些处方错误的主要驱动因素.
- 临床监测对于该群体的安全药物管理至关重要.
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