Renal impairment:: a challenge for opioid treatment?: The role of buprenorphine
Renal impairment:: a challenge for opioid treatment?: The role of buprenorphine
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DOI：
10.1191/0269216306pm1127oa
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发表时间：
2006-01-01
影响因子：
4.4
通讯作者：
Böger, RH
中科院分区：
文献类型：
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作者：
Böger, RH
由于肾排泄功能随年龄增长而下降，肾功能受损在老年患者中很常见。此外，高血压、糖尿病等许多疾病都与肾功能加速衰退有关。肾功能障碍影响化合物的代谢，因此对药物安全具有重要的治疗作用。对于肾功能下降的疼痛患者，例如接受姑息治疗的患者，大多数用于慢性疼痛治疗的阿片类药物应减少剂量，增加剂量间隔，或根本不服用，因为存在母体化合物或其代谢物蓄积的风险。例如，对于吗啡或可待因，活性代谢物在肝脏中形成并由肾脏清除，因此在肾功能障碍的情况下可能会积聚。相反，丁丙诺啡可以以正常剂量用于肾功能不全的患者，因为它主要通过肝脏排泄。在接受定期血液透析治疗的患者中，透析期间阿片类药物的去除因人而异，具体取决于多种因素，包括所使用的透析技术。由于透析期间代谢物可能“反弹”，吗啡在血液透析患者中似乎难以处理。相比之下，丁丙诺啡在血液透析患者中的药代动力学没有变化，这意味着不需要减少该药物的剂量。因此，对于肾功能下降、慢性肾功能不全和血液透析的患者，在开始阿片类药物治疗时，丁丙诺啡似乎是一个安全的选择。
Impairment of renal function is common among elderly patients due to an age-related decline in renal excretory function. In addition, many diseases such as hypertension and diabetes mellitus are associated with an accelerated decline in renal function. Renal dysfunction affects the metabolism of compounds and thus has important therapeutic consequences for drug safety. For pain patients who have reduced renal function such as those in palliative care, most opioids used for chronic pain treatment should be administered at reduced dosages, with increased dosage intervals, or not at all because of the risk of accumulation of the parent compound or its metabolites. For instance, for morphine or codeine, active metabolites are formed in the liver and cleared by the kidney and may therefore accumulate in cases of renal dysfunction. In contrast, buprenorphine can be administered at normal doses in patients with renal dysfunction because it is mainly excreted through the liver. In patients undergoing regular haemodialysis treatment, removal of an opioid during dialysis varies between individuals based upon a number of factors including the dialysis technique used. Morphine appears to be difficult to process in haemodialysis patients due to possible 'rebound' of metabolites between dialysis sessions. By contrast, the pharmacokinetics of buprenorphine are unchanged in haemodialysis patients, which means that there is no need for dose-reduction with this drug. Thus, in patients with reduced renal function, chronic renal insufficiency and haemodialysis, buprenorphine appears to be a safe choice when opioid treatment is initiated.