Blood purification pharmacokinetics Shanghai Jiaotong University College of Medicine subsidiary Ruijin Hospital kidney Chen Nan-J) N FWR; t Blood purification technology in clinical treatment of acute and chronic renal failure has been nearly half a century， and in critically ill patients， such as acute renal failure (ARF) in the treatment of continuous renal replacement therapy (CRRT) more traditional intermittent hemodialysis greater advantages， its clinical application is gradually expanded from the traditional kidney renal replacement to support development， participate in a multidisciplinary critical severe _ (HwU> Whether or ARF in patients with CRF usually kinds of medication， drugs in the application of these patients should be in accordance with its residual renal function adjustment， and at the same time， blood purification and changed the drug metabolism in patients with these conditions， particularly in critically ill patients， such as failure to consider this factor， medication adjustment programmes， the consequences could be Q: bKT # / 1) from the following three aspects of the assessment of patients with blood purification P (rS - `I First， the nature of drug j1ZFsTFMWp 1， renal clearance in the proportion of drug: drug in the body's overall clearance rate is the body organ system capacity to remove the sum of drugs， including liver， kidney， as well as other metabolic If drugs mainly through kidney removal， which is usually to remove CRRT part of the in vitro clear / removal of the overall ≥ 25 ~ 30%， it is necessary to adjust the Pio ^ 5j hB6 2， protein binding rate: drug free with biological activity and can be removed filtration， plasma protein binding is the high rate of drugs (such as digitalis glycosides drug， warfarin， ) are difficult to remove CRRT Protein binding rate can be affected by many factors， the theoretical value and the actual situation may have some ! A! / S / x4 3， molecular weight: small molecular diffusion easy to be adopted by dialysis membrane pore， drug removals and molecular size inversely proportional to macromolecules often convection through， unless more than its molecular weight film hole size， or ultrafiltration rate associated with the Most of the molecular weight of less than 500 drug Da， Da little more than Extension of high-flux dialysis membrane and time of removal can be improved 'T [zh # v> S 4， the volume of distribution (Vd): in vivo drug representatives of the extent of the Vd representative of the high rate of drug organizations with high clearance rate is Vd patients with severe and theoretical value can be very different， but there are individual Drug Vd ≤ 1 L / kg easy clearance， ≥ 2 L / kg difficult to be High flow could be higher IHD Vd drug rapidly cleared from plasma， serum concentration decreased， but only in a dialysis drug remove a small part in the two dialysis between plasma concentration will quickly CRRT continued slow clearance high Vd drugs， the process of drug plasma from the organizations to re-distribution， the change in the plasma concentration of ( 3， blood and dialysis fluid flow rate: the faster the velocity， the more easily access drug dialysis membrane into the dialysis solution in the dialysis fluid flow faster， drug dialysis fluid outflow from the faster to maintain the required gradient # J a `+ w) Third， the patient's own | (a] P = 9X， Cefaclor 1 25 24-35 25-5 tid not adjusted to 25 sU? "V Cefoperazone 6-5 90 14-20 1-2 q12h thoroughly after delivery without adjustment?，: # 9 Cefuroxime 2 33 13-18 75-5 q8h thoroughly after administration 0 q12h * i? RJH Ceftazidime 2 17 28-4 1-0 q8h 0 1-0 q24-48h YxE bg (Y Amikacin 4-3 <5 22-29 5mg/kg q12h 2 / 3 of the normal 30-70% q12-18h wI! + L & Q Tobramycin 5 <5 22-33 7mg/kg q8h 2 / 3 of the normal 30-70% q12h lC = N: = Mu Ciprofloxacin 3-6 20-40 5 5-75 q12h 25 q12h 2 q12h， $ h (fM8GC Levofloxacin 4-8 24-38 1-5 5 q24h 25-50% 50% + T， H & # Imipenem 1 13-21 17-3 5-0 q6h thoroughly after administration 50 percent - J "qrp Z ^ Vancomycin 6-8 10-50 47-1 5 q6h 5 q48-q24-96h 5% 48h c X: 3 30 4 losartan 50mg qd-q12h unclear hundred percent jq57C)) X 2 Benazepril 22 95 15 10mg qd not 50-75% uw K h Monopril 12 95 15 10mg qd not 100% [T'yc: = Atenolol 7 45-60 5-10 50-100mg qd 25-50mg 50% q48h s ULIrYRA The name of the drug half-life F Ze: co8Mu (H) protein binding 0zw + @ l ` (%) Vd `" a? A 5] k (L / Kg) renal function f) * NX After the normal dose HD ^ fs m6 f)) SUPPLEMENTARY of CRRT j ~ Q) F | i8 Carvedilol 5-8 95 1-2 25-50mg q12-24h not 100 percent [6AHaOhR ' Nifedipine 4-5 97 4 10-20mg q6-8h not 100%> s & XX， w Amlodipine 35-50 95 21 5mg qd not 100 percent 1p8: 1) q Felodipine 10-14 99 9-10 10mg qd not 100% gs? 8Wzh90 * Digoxin 36-44 20-30 5-8 25-5mg qd not 25-75% q36h H4t) + (: D ' Low-molecular-weight heparin 2-0 unclear 06-13 30-40mg bid unclear 100% p "2m9 0IO Warfarin 34-35 99 15 load 10-15 mg of 2-10 mg qd not iHPUmTus not -- Azathioprine 16-1 20 55-8 5-5mg/kg q24h 25mg/kg 75% yq?] V7 ~ Cyclophosphamide 4-5 14-20 5-1 1-5mg/kg qd 1 / 2 dose of 100% Z:! IX ^ q;) n Vincristine 1-5 75 5-11 4mg / sq m unclear 100% I! P4 (3skAB Prednisone 5-5 80 2 5-60mg qd not 100% X x_ tpC? Prednisolone 5-5 80 2 5-60mg qd need 100 percent OZf6/10O / A prednisone 9-0 40-60 2-5 4-48mg qd not 100 percent [@ / /) # 5v Insulin 2-4 5 15 Indefinite not 75% `([R j M` Acarbose 3-9 15 32 50-200mg tid unclear avoid / 'ZKST4 Effects of Fluvastatin small 5-1 98 42 2-10mg qd unclear 100% k O1)? DWpa Simvastatin 2> 95 mg qd unclear 5-40 unclear 100%
