肾毒素管理的当代考虑因素:估算肾功能和使用新型生物标记物

IF 1.3 Q4 PHARMACOLOGY & PHARMACY
Sandra L. Kane-Gill Pharm.D., M.Sc., FCCP, Nabihah Amatullah Pharm.D., Tiffany Tran Pharm.D., Iman Karimzadeh Ph.D.
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引用次数: 0

摘要

药物相关性急性肾损伤(D-AKI)约占住院患者急性肾损伤(AKI)病例总数的 19%-26%。值得注意的是,D-AKI 诊断后的最佳药物管理往往存在缺陷,只有约一半的患者停用肾毒性药物,五分之一的患者避免继续使用肾毒性药物。肾毒性药物管理涉及协调护理管理策略的应用,以确保安全使用肾毒性药物和肾脏排毒药物。本文旨在回顾肾毒性药物管理策略,并强调估算肾功能和使用新型生物标记物作为管理计划一部分的现代考虑因素。慢性肾脏病流行病学协作组(CKDEPI)2021 年血清肌酐计算公式目前被推荐用于估算美国大多数临床情况下成人的肾功能。现在是时候重新评估医疗保健专业人员如何看待使用非指数化、不分种族的 CKDEPI 2021 方程估算肾功能以确定药物剂量了。此外,预计血清胱抑素 C (CysC) 将得到广泛应用,因此需要进一步评估纳入血清 CysC 的肾小球滤过率估算公式,以便提出药物剂量建议,以及如何使用血清 CysC 来补充基于血清肌酐的公式。最后,新型肾脏应激/损伤生物标志物应被视为 D-AKI 预测、诊断和预后复杂情况中的一个环节,并应与其他诊断标准一起结合患者的临床状况进行解释。这些有关药物剂量和 D-AKI 管理的现代考虑因素是肾毒性药物管理的重要组成部分。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Contemporary considerations for nephrotoxin stewardship: Estimating kidney function and use of novel biomarkers

Contemporary considerations for nephrotoxin stewardship: Estimating kidney function and use of novel biomarkers

Drug-associated acute kidney injury (D-AKI) constitutes approximately 19%–26% of all acute kidney injury (AKI) cases in hospitalized patients. Notably, there is often a deficiency in optimal drug management after D-AKI diagnosis, with only about half of the patients experiencing discontinuation of nephrotoxins and one-fifth avoiding further nephrotoxin administration. Nephrotoxin stewardship involves the application of coordinated care management strategies to ensure the safe utilization of nephrotoxins and renally eliminated medications. The purpose of this paper is to review nephrotoxin stewardship strategies and highlight contemporary considerations for estimating kidney function and the use of novel biomarkers as part of the stewardship program. The Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) 2021 serum creatinine formula is now recommended for estimating kidney function for adults in most clinical situations in the United States. It is time to reevaluate how healthcare professionals think of estimating kidney function for drug dosing with the use of the non-indexed, race-free, CKDEPI 2021 equation. In addition, widespread use of serum cystatin C (CysC) is anticipated so estimated glomerular filtration rate equations that incorporate serum CysC will need to be further evaluated for drug dosing recommendations and how the use of serum CysC can complement serum creatinine-based equations. Lastly, novel kidney stress/damage biomarkers should be viewed as a piece of a complex scenario of D-AKI prediction, diagnosis, and prognosis and should be interpreted along with other diagnostic criteria in relation to the clinical condition of the patient. These contemporary considerations for drug dosing and D-AKI management are important components of nephrotoxin stewardship.

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