Management of End-stage Renal Disease Associated with Systemic Rheumatic Diseases.
Management of End-stage Renal Disease Associated with Systemic Rheumatic Diseases.
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DOI：
10.31662/jmaj.2019-0020
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发表时间：
2020-01-15
期刊：
影响因子：
--
通讯作者：
Harigai M
中科院分区：
文献类型：
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作者：
Honda S;Katsumata Y;Karasawa K;Yamanaka H;Harigai M
过去几十年来，风湿性疾病 (RD) 的治疗效果有所改善。然而，仍有相当一部分患者患有终末期肾病（ESRD），必须承受血液透析的负担。从医学和医疗经济学的角度来看，防止 RD 患者发展为 ESRD 至关重要。对于那些已经患有 ESRD 的患者来说，通过适当管理与 ESRD 相关的疾病活动和合并症来改善小瓶预后和生活质量非常重要。因此，风湿病学家和肾脏病学家需要认识到与进展为 ESRD 相关的风险因素以及适当的治疗方法。尽管大多数 RD 的活性在开始血液透析后往往会降低，但疾病活动度仍可能增加，因此即使在发生 ESRD 后，认识到如何正确使用免疫抑制剂至关重要。 RD的治疗需要格外关注，因为羟氯喹需要更频繁地监测药物不良反应；对于吗替麦考酚酯、环孢素 A 和他克莫司，治疗药物监测是必要的；环磷酰胺和硫唑嘌呤需要调整剂量； ESRD 患者禁用甲氨蝶呤和布西拉明；来氟米特和柳氮磺吡啶不需要显着减少剂量，而艾拉莫德应谨慎给药。利妥昔单抗或贝利尤单抗等生物制剂的药代动力学不受 ESRD 影响，无需调整剂量。风湿病学家和肾脏病学家之间的合作比以往任何时候都更加必要，并有望在临床环境中产生互补效应并取得更好的结果，尽管这种合作并不总是进行得当。
The outcomes of rheumatic diseases (RDs) have improved over the past decades. However, a significant proportion of the patients still suffer from end-stage renal disease (ESRD) and have to bear the burden of hemodialysis. It is crucial to prevent patients with RDs from developing ESRD from viewpoints of medicine and medical economics. For those who already have ESRD, it is important to improve vial prognosis and quality of life through appropriate management of disease activity and comorbidities related to ESRD. Thus, rheumatologists and nephrologists need to recognize risk factors associated with progression to ESRD along with their appropriate management. Although the activity of most RDs tends to decrease after initiation of hemodialysis, disease activity may still increase, and recognizing how to appropriately use immunosuppressive agents even after the development of ESRD is crucial. The treatment of RDs needs extra attention as hydroxychloroquine requires more frequent monitoring for adverse drug reactions; therapeutic drug monitoring is necessary for mycophenolate mofetil, cyclosporine A, and tacrolimus; cyclophosphamide and azathioprine need dose adjustments; methotrexate and bucillamine are contraindicated in patients with ESRD; leflunomide and sulfasalazine do not require significant dose reduction and iguratimod should be carefully administered. The pharmacokinetics of biological agents such as rituximab or belimumab are not affected by ESRD, and dose adjustments are not necessary. Collaboration between rheumatologists and nephrologists is needed more than ever and is expected to produce a complementary effect and achieve better outcomes in clinical settings, although this cooperation has not always been conducted appropriately.