《抗肿瘤药物治疗期间肾损伤管理临床实践指南(2022)》解读(四):肾损伤患者抗肿瘤药物的剂量调整(第1部分)

Interpretation of Clinical Practice Guidelines for Management of Kidney Injury During Anticancer Drug Therapy 2022(Ⅳ):dose adjustment of anticancer drug in patients with impaired kidney function(Part 1)

肾功能不全患者由于肾脏的排泄功能下降或延迟以及与肾功能下降相关的药物代谢动力学改变,可能导致药物或其代谢物在体内蓄积,药物不良反应发生的风险增加。因此,肾功能不全患者在进行抗肿瘤药物治疗时需要调整药物剂量。日本肾脏病学会、日本临床肿瘤学会、日本医学肿瘤学会和日本肾脏病药物治疗学会共同制订的《抗肿瘤药物治疗期间肾损伤管理临床实践指南(2022)》的第二章中专门论述了肾损伤患者抗肿瘤药物的剂量调整。本文重点解读该章节中肾功能不全患者药物剂量调整的原则和铂类药物、氟尿嘧啶类药物的剂量调整建议。

Accumulation of drugs and its metabolites in the body occurs and risks of adverse drugreactions increase in renal insufficiency patients due to the renal function decline or delay of renal excretionand the pharmacokinetic changes related to the decline of renal function.Therefore,the dose of anticancerdrugs should be adjusted in tumor patients with renal dysfunction.The Japanese Society of Nephrology,JapanSociety of Clinical Oncology,Japanese Society ofMedical Oncology,and Japanese Society of Nephrologyand Pharmacotherapy have jointly formulated Clinical Practice Guidelines for Management of Kidney Injury During Anticancer Drug Therapy 2022,and specifically discusses the dose adjustment of anticancer drug forpatients with renal injury in the second chapter.This article focuses on the interpretation of the principle ofdrug dose adjustment for patients with renal insufficiency and suggestions for dose adjustment of platinumdrugs and fluorouracil drugs in this chapter.