Böbrek Fonksiyon Bozukluğu Olan Hastalarda İlaç Kullanımı
Özet
Böbrekler, ilaçların ve metabolitlerinin vücuttan atılmasında rol oynayan ana organlardır. Böbrek fonksiyonlarındaki azalmalar, ilaçların farmakokinetik ve farmakodinamik profillerini doğrudan değiştirerek renal klerensin düşmesine, yarı ömrün uzamasına ve buna bağlı olarak toksisite ile yan etkilerin artmasına yol açar. Bu durum, özellikle yoğun bakım ünitelerinde (YBÜ) yatan akut (ABY) veya kronik böbrek yetmezliği (KBY) olan hastalar ile diyaliz tedavisi gören bireylerde büyük önem taşır. Tedavi etkinliğini korumak ve ilaç kaynaklı nefrotoksisitenin önüne geçmek amacıyla, hastaların böbrek işlevleri Cockcroft-Gault, MDRD veya CKD-EPI formülleriyle hesaplanan tahmini glomerüler filtrasyon hızına (GFH) göre yakından takip edilmelidir. Tedavi sürecinde idame dozlarının azaltılması veya uygulama aralıklarının uzatılması gibi bireyselleştirilmiş doz ayarlamaları yapılmalıdır. Özellikle dar terapötik aralığa sahip ilaçlarda kan düzeyi takibi kritik bir gerekliliktir. Periton diyalizi, aralıklı hemodiyaliz ve sürekli renal replasman gibi farklı diyaliz tekniklerinin ilaç klerensi üzerindeki değişken etkileri de mutlaka göz önünde bulundurulmalıdır.
The kidneys are the primary organs involved in the excretion of drugs and their metabolites. A decrease in renal function directly alters the pharmacokinetic and pharmacodynamic profiles of drugs, leading to reduced renal clearance, prolonged half-life, and a subsequent increase in toxicity and adverse effects. This situation is of crucial importance, particularly for patients with acute kidney injury (AKI) or chronic kidney disease (CKD) hospitalized in intensive care units (ICUs), as well as individuals undergoing dialysis. To maintain therapeutic efficacy and prevent drug-induced nephrotoxicity, patients' renal functions must be closely monitored using the estimated glomerular filtration rate (GFR) calculated via the Cockcroft-Gault, MDRD, or CKD-EPI formulas. Individualized dosage adjustments, such as reducing maintenance doses or extending administration intervals, should be implemented during treatment. Therapeutic drug monitoring is a critical requirement, especially for drugs with a narrow therapeutic index. Furthermore, the variable effects of different dialysis modalities, including peritoneal dialysis, intermittent hemodialysis, and continuous renal replacement therapy, on drug clearance must be carefully evaluated.
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