Pharmakotherapie bei Niereninsuffizienz – Fokus Chemotherapie, neue Antikoagulanzien, neue Antidiabetika

Die Pharmakotherapie bei Niereninsuffizienz spielt im klinischen Alltag vor dem Hintergrund steigender Lebenserwartung und zunehmendem Patientenalter eine immer wichtigere Rolle. Das Ziel einer adäquaten Dosisanpassung ist die Vermeidung von sowohl Über- als auch Unterdosierungen, sodass einerseits übermäßige Nebenwirkungen und andererseits mangelnde Therapieeffektivität vermieden werden. Eine korrekte Dosisanpassung erfordert die Beachtung sowohl pharmakokinetischer als auch pharmakodynamischer Regeln. Unter Kenntnis der renalen Eliminationsfraktionen von Muttersubstanz und relevanten Metaboliten sowie der individuellen GFR kann die erforderliche Dosisanpassung nach Dettli berechnet werden. Häufig besteht die Möglichkeit der Anwendung ähnlich wirksamer, aber im Rahmen der Niereninsuffizienz besser geeigneter Arzneimittel. Oft finden sich, sowohl in der Tumor- als auch in der Diabetes- oder Antikoagulationstherapie für definierte Substanzklassen Wirkstoffe, die von der Nierenfunktion unabhängig sind. Andernfalls sollte eine Dosisanpassung möglichst nach Zielspiegel berechnet werden.

Pharmacotherapy in renal impairment plays an increasingly important role in our daily clinical routine. The aim of an adequate dose adjustment is to avoid both, over- and under-dosing with consequences of excessive side effects or ineffectiveness of therapy. Adequate dose adjustment must consider pharmacokinetics as well as pharmacodynamics. Following the rules of Dettli, the general dose adjustment can be calculated by knowing the fraction of a drug that is eliminated by the renal route and the individual GFR of the patient. Often there are options of applying similar effective, but more suitable alternative drugs that are independent form kidney funciton. Frequently, such alternatives are even available within defined drug groups. Otherwise, dose adjustment is needed. Concentration dependent effects require adequate peak levels, whereas time dependent effects require adequate trough levels.

Key words

Kidney dysfunciton - pharmacokinetics - pharmacodynamics - anti cancer drugs - antidiabetics - anticoagulants

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