Der Nephrologe

, Volume 2, Issue 4, pp 270–278 | Cite as

Pharmakotherapie

Leitthema
  • 124 Downloads

Zusammenfassung

Für Dialysepatienten wichtige Medikamente sind Antihypertensiva, Antidiabetika, Blutbildungshormone, Osteopathiebehandlung, Cholesterinsenker und Schmerzmedikamente. Lebensentscheidend können Antibiotika und ihre richtige Dosierung sein. Zwei Fragen stellen sich: 1. welches Medikament ist für die jeweilige Indikation zu bevorzugen, und 2. welche Dosis muss man geben. Am Beispiel der Cefazolin-Dosierung werden die Dettli-Regel und die Kunin-Regel der Dosisberechnung erläutert. Dosierungsempfehlungen für Cefazolin bei kontinuierlicher Hämofiltration mit einem Kreatinin von 3,96 mg/dl und bei intermittierender Dialyse werden aus den Regeln abgeleitet.

Schlüsselwörter

Pharmakokinetik Pharmakotherapie Dosisanpassung Dialysepatienten Antibiotika 

Pharmacotherapy

Abstract

Dialysis patients need drugs for hypertension, diabetes, anemia, osteopathy, cholesterol, and pain. Antimicrobial agents and the correct dose may have vital impact in the intensive care setting. Two questions must be answered: (1) what is the right drug for the symptom and (2) what is the right dose? For the example of cefazolin the Dettli rule and the Kunin rule are illustrated to adjust the dose. Dosage recommendations for cefazolin are given for the case of hemofiltration with a creatinine of 3.96 mg/dl and for the case of anuria and intermittent hemodialysis.

Keywords

Pharmacokinetics Pharmacotherapy Dose adjustment Dialysis patients Antibiotics 

Literatur

  1. 1.
    Benet LZ, Hoener BA (2002) Changes in plasma protein binding have little clinical relevance. Clin Pharmacol Ther 71: 115–121PubMedCrossRefGoogle Scholar
  2. 2.
    Block GA, Raggi P, Bellasi A et al. (2007) Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients. Kidney Int 71: 438–441PubMedCrossRefGoogle Scholar
  3. 3.
    Boesler B, Czock D, Keller F et al. (2005) Clinical course of haemodialysis patients with malignancies and dose-adjusted chemotherapy. Nephrol Dial Transplant 20: 1187–1191PubMedCrossRefGoogle Scholar
  4. 4.
    Buijk SE, Mouton JW, Gyssens IC et al. (2002) Experience with a once-daily dosing program of aminoglycosides in critically ill patients. Intensive Care Med 28: 936–942PubMedCrossRefGoogle Scholar
  5. 5.
    Dettli L (1976) Drug dosage in renal disease. Clin Pharmacokinet 1: 126–134PubMedGoogle Scholar
  6. 6.
    Ekstrom P, Carling L, Wetterhus S et al. (1996) Prevention of peptic ulcer and dyspeptic symptoms with omeprazole in patients receiving continuous non-steroidal anti-inflammatory drug therapy. A Nordic multicentre study. Scand J Gastroenterol 31: 753–758PubMedGoogle Scholar
  7. 7.
    Elung-Jensen T, Heisterberg J, Sonne J et al. (2005) Enalapril dosage in progressive chronic nephropathy: a randomised, controlled trial. Eur J Clin Pharmacol 61: 87–96PubMedCrossRefGoogle Scholar
  8. 8.
    Elung-Jensen T, Heisterberg J, Kamper AL et al. (2003) Blood pressure response to conventional and low-dose enalapril in chronic renal failure. Br J Clin Pharmacol 55: 139–146PubMedCrossRefGoogle Scholar
  9. 9.
    Gago-Dominguez M, Yuan JM, Castelao JE et al. (1999) Regular use of analgesics is a risk factor for renal cell carcinoma. Br J Cancer 81: 542–548PubMedCrossRefGoogle Scholar
  10. 10.
    Guan Y, Hao C, Cha DR et al. (2005) Thiazolidinediones expand body fluid volume through PPARgamma stimulation of ENaC-mediated renal salt absorption. Nat Med 11: 861–866PubMedCrossRefGoogle Scholar
  11. 11.
    Haubitz M, Bohnenstengel F, Brunkhorst R et al. (2002) Cyclophosphamide pharmacokinetics and dose requirements in patients with renal insufficiency. Kidney Int 61: 1495–1501PubMedCrossRefGoogle Scholar
  12. 12.
    Keller F, Griesshammer M, Haussler U et al. (2001) Pregnancy and renal failure: the case for application of dosage guidelines. Drugs 61: 1901–1920PubMedCrossRefGoogle Scholar
  13. 13.
    Kunin CM (1967) A guide to use of antibiotics in patients with renal disease. A table of recommended doses and factors governing serum levels. Ann Intern Med 67: 151–158PubMedGoogle Scholar
  14. 14.
    Labenz J, Blum AL, Bolten WW et al. (2002) Primary prevention of diclofenac associated ulcers and dyspepsia by omeprazole or triple therapy in Helicobacter pylori positive patients: a randomised, double blind, placebo controlled, clinical trial. Gut 51: 329–335PubMedCrossRefGoogle Scholar
  15. 15.
    Mihatsch MJ, Khanlari B, Brunner FP (2006) Obituary to analgesic nephropathy–an autopsy study. Nephrol Dial Transplant 21: 3139–3145PubMedCrossRefGoogle Scholar
  16. 16.
    Ozkahya M, Ok E, Toz H et al. (2006) Long-term survival rates in haemodialysis patients treated with strict volume control. Nephrol Dial Transplant 21: 3506–3513PubMedCrossRefGoogle Scholar
  17. 17.
    Phakdeekitcharoen B, Leelasa-nguan P (2004) Effects of an ACE inhibitor or angiotensin receptor blocker on potassium in CAPD patients. Am J Kidney Dis 44: 738–746PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Sektion Nephrologie,Klinik für Innere Medizin IZentrum Innere Medizin,Universitätsklinikum UlmUlmDeutschland

Personalised recommendations