Medication safety in chronic kidney disease.

IF 2.2 3区医学 Q3 PERIPHERAL VASCULAR DISEASE

Current Opinion in Nephrology and Hypertension Pub Date : 2023-09-01 DOI:10.1097/MNH.0000000000000907

Sonal Singh

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引用次数: 1

Abstract

Purpose of review: Several drugs cause nephrotoxicity and accelerate progression of chronic kidney disease (CKD). The objective of this review is to summarize recent evidence on drugs that either increase the risk of nephrotoxicity, progression of CKD or drug induced harm in patients with CKD.

Recent findings: Bisphosphonates and hypnotics increase the progression of CKD, whereas denosumab does not accelerate progression of CKD. Tenofovir disoproxil fumarate (TDF) increases the risk of renal tubular toxicity and adverse effects on bone, but Tenofovir alafenamide (TAF) and Tenofovir amibufenamide (TMF) have favorable safety profile on the kidneys and bones. Although no dosage adjustment is needed for Oral Nirmatrelvir/Ritonavir in patients with mild renal impairment and coronavirus disease 2019, the dosage is reduced to twice daily in those with moderate renal impairment. It is not recommended in patients with severe renal impairment. The prescribing information does not recommend use of remdesevir below glomerular filtration rate (eGFR) < 30 ml/min but recent studies suggest that remdesevir may be safe and effective in patients with varying levels of CKD severity. Molnupiravir does not require dose adjustment in patients with CKD.

Summary: Several medications increase the risk of development of acute kidney injury or progression of CKD. Close attention is needed to select the appropriate dose or safer alternatives to reduce the risk of drug-induced harm in patients with CKD.

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慢性肾脏疾病的用药安全性。

综述目的:几种药物引起肾毒性并加速慢性肾脏疾病(CKD)的进展。本综述的目的是总结最近的证据表明，药物会增加CKD患者肾毒性、CKD进展或药物诱导损害的风险。最新发现:双膦酸盐和催眠药会增加CKD的进展，而地诺单抗不会加速CKD的进展。富马酸替诺福韦二oproxil (TDF)增加肾小管毒性和对骨骼的不良影响的风险，但替诺福韦alafenamide (TAF)和替诺福韦amibufenamide (TMF)对肾脏和骨骼具有良好的安全性。尽管在轻度肾功能损害和2019冠状病毒病患者中口服尼马特利韦/利托那韦不需要调整剂量，但在中度肾功能损害患者中，剂量减少到每天两次。严重肾功能不全的患者不推荐使用。处方信息不建议在肾小球滤过率(eGFR) < 30 ml/min时使用瑞德西韦，但最近的研究表明，瑞德西韦对不同程度CKD严重程度的患者可能是安全有效的。慢性肾病患者不需要调整Molnupiravir的剂量。总结:几种药物可增加急性肾损伤或CKD进展的风险。需要密切注意选择合适的剂量或更安全的替代品，以减少CKD患者药物性伤害的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Nephrology and Hypertension 医学-泌尿学与肾脏学

CiteScore

5.70

自引率

6.20%

发文量

132

审稿时长

6-12 weeks

期刊介绍： A reader-friendly resource, Current Opinion in Nephrology and Hypertension provides an up-to-date account of the most important advances in the field of nephrology and hypertension. Each issue contains either two or three sections delivering a diverse and comprehensive coverage of all the key issues, including pathophysiology of hypertension, circulation and hemodynamics, and clinical nephrology. Current Opinion in Nephrology and Hypertension is an indispensable journal for the busy clinician, researcher or student.