Variation in the non-renal clearance of drugs and its factors in end stage kidney disease

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  • 末期腎不全時に腎外クリアランスが変動する薬剤とその要因
  • マッキ ジンフゼンジ ニ ジンガイ クリアランス ガ ヘンドウ スル ヤクザイ ト ソノ ヨウイン

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The objective of this review is to draw people’s attention to the unexpected variation in non-renal drug clearance in patients with end-stage kidney disease (CKD stage V). As listed below, this review describes some cases of increase of bioavailability, decrease of hepatic clearance, and increase of non-renal clearance in patients with end-stage kidney disease: <br> 1. Cases of increase of bioavailability: propranolol and pravastatin<br> 2. Cases of inhibition of hepatic metabolism: losartan and warfarin<br> 3. Cases of inhibition of hepatic uptake: erythromycin, fexofenadine, and digoxin<br> 4. Cases of increase of non-renal clearance: CPT-11<br> 5. Cases of disease-specific drug interaction: interaction between colchicine and clarithromycin, and digoxin and fexofenadine<br> The abovementioned cases show that we should be careful about not only the decrease in renal function but also the variation in non-renal function, such as increase of bioavailability, decrease of hepatic clearance, and increase of non-renal clearance in patients with end-stage renal failure. In addition, we should be cautious that patients with normal renal function do not suffer from unexpected drug interaction.

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