만성 신장 질환에서의 약동학적 고려 사항의 최근 동향

초록

Chronic kidney disease (CKD) is a globally increasing disease, and if not treated appropriately, it can progress to end-stage renal failure, requiring renal replacement therapy, which poses a significant socioeconomic burden. Therefore, recognizing the importance of early diagnosis and treatment of CKD is essential to slow disease progression and improve the quality of life for patients. CKD is a complex disease that causes various complications, and patients often receive multiple medications, increasing the risk of drug-drug interactions and the potential for drug accumulation, which heightens the risk of adverse effects. Proper management, such as controlling hypertension, can prevent or delay the onset of CKD. During treatment, various methods, including adjusting drug doses and extending dosing intervals, should be actively utilized. In CKD patients, the efficacy and side effects of medications can change. Delayed gastric emptying, acidosis, and other factors can decrease drug absorption, while fluid overload and hypoalbuminemia can affect tissue distribution. With the decline in renal function, the metabolism and excretion of drugs also change, impacting drug concentrations and effects. These changes are influenced by drug transporters and metabolic enzymes altered by CKD. In particular, dialysis patients show different systemic clearance of drugs, making dose adjustments essential. Considering these factors, optimal pharmacotherapy for CKD patients must be carefully managed. Drugs that are excreted through the kidneys require dose adjustments based on renal function, and both loading doses and maintenance doses should be appropriately set to maximize therapeutic effects and minimize side effects.

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