Hemodialysis of theophylline in uremic patients.

Hemodialysis of theophylline was studied in three uremic patients. The dialysis clearance ranged from 75.6 to 97.9 ml/min and averaged 88.1 ml/min. A much smaller value of 32.8 ml/min was reported by Levy and associates. The difference may be attributed to the two monitoring factors during hemodialysis, namely, blood and dialyzate flow rates. Both were higher in our study. Analysis of the semilogarithmic plots of the arterial plasma concentration versus time over a 3-hour period gave apparent half-lives of 3.15, 2.04, and 2.73 hours, respectively, for the three patients. Half-life of theophylline in normal subjects ranged from 4 to 6 hours or even longer. A prolonged half-life of theophylline in uremia could be expected. Our kinetic study indicated an approximately 50 per cent reduction in terminal half-life during hemodialysis. Hourly dialyzate was collected from one patient to account for drug recovery in the dialysis fluid. Forty per cent of the administered dose was recovered in the dialyzate during a 3-hour dialysis period, indicating effective removal. Dialysis clearance for creatinine was calculated by arterial-venous difference and correlated with that of theophylline. We found that theophylline was cleared by the dialyzer at a rate approximating 63 per cent of creatinine removal.     

尿毒清颗粒对血液透析患者高磷血症控制作用的临床研究

目的观察尿毒清颗粒对维持性血液透析患者高磷血症的控制作用。方法选择行维持性血液透析的慢性肾脏病患者24例,患者经常规治疗其高磷血症仍控制不良。患者在保持饮食及基础治疗不变的基础上,予常规碳酸钙口服2个月后,给予口服尿毒清颗粒一日2次,每次10g,治疗2个月,观察治疗前后血磷、钙水平,钙磷乘积和iPTH变化。结果尿毒清颗粒治疗后血清磷、钙磷乘积较治疗前均明显降低（P〈0．01）,与对照期相比,治疗期血磷降低（0．22±0．23）mmol／L,钙磷乘积降低（7．30±6．91）（mg／dL）^2,差异均有统计学意义（P〈0．01）,未发现对钙和iPTH水平的影响。结论尿毒清颗粒可以有效改善高磷血症,适用于血液透析患者常规治疗后仍存在高磷血症患者的辅助治疗。     

不同血流量对尿毒症血液灌流患者甲状旁腺素清除效果的影响

目的 观察不同血流量对尿毒症血液灌流(HP)患者甲状旁腺素(PTH)清除效果的影响.方法 33例尿毒症维持性血液透析(HD)患者随机分成血流量200 mL/min组(n=17)和250 mL/min组(n=16)分别行HD+HP联合治疗.比较两组治疗后血PTH水平变化,观察透析器的凝血情况.结果 两组患者治疗后血PTH均显著降低(P<0.001),两组间差异无统计学显著性(P>0.05).200 mL/min组有4例(23.5%)透析器发生凝血,250 mL/min组均未发生凝血.结论 采用250和200 mL/min血流量进行HP治疗对PTH的清除效果相同,为临床减低肝素剂量提供一定的依据.     

Hemodialysis clearance of pentobarbital during continuous infusion

The hemodialysis clearance of pentobarbital during continuous infusion was determined in a 34-year-old man in acute renal failure. Pentobarbital specimens were obtained simultaneously from arterial blood entering and leaving the dialysis machine at five 1-h intervals. The mean hemodialysis clearance of pentobarbital was 22.3 ml/min. Pentobarbital concentration was relatively unaffected throughout the dialysis period, because of the high dose and continuous infusion of a drug with low hepatic intrinsic clearance and a short dialysis period. A large contribution to total body clearance was not evident, and dosage adjustment would have been unwarranted.     

Hemodialysis clearance of encainide and metabolites.

The disposition of encainide and metabolites O-desmethylencainide (ODE) and 3-methyl-ODE (MODE) was evaluated in a 31-year-old hemodialysis patient following a 25 mg oral dose during an interdialytic period and a second 25 mg oral dose 48 h later, 2 h before a hemodialysis procedure. The inter- and intradialytic elimination half-lives were not different for encainide and its metabolites ODE and MODE. The hemodialysis clearance of encainide, MODE, and ODE are all less than 10% of the creatinine clearance of the dialyzer. Thus, hemodialysis does not result in clinically significant removal of encainide or its metabolites.     

尿毒清颗粒对腹膜透析患者全身微炎症状态的影响

目的探讨尿毒清颗粒对腹膜透析患者全身微炎症状态的影响。方法将40例患者随机分为对照组与治疗组,各20例。两组常规治疗相同,治疗组在常规治疗基础上给予尿毒清颗粒冲服,5 g/次,4次/d。连续服药3个月后,观察治疗前后血清hs-CRP及IL-6水平变化。结果治疗后,两组hs-CRP、IL-6水平均降低(P<0.05);两组组间比较,差异有统计学意义(P<0.05)。结论尿毒清颗粒对腹膜透析患者全身微炎症状态有明显改善作用,且安全性较高,值得临床推广应用。     

血液透析联合血液灌流治疗尿毒症继发性甲状旁腺功能亢进症的疗效观察及护理

目的 观察血液透析联合血液灌流及护理干预对尿毒症继发甲状旁腺功能亢进的治疗效果.方法 将50例尿毒症继发甲状旁腺功能亢进患者随机分为常规血液透析组（A组）、血液透析联合血液灌流组（B组）;两组均予一系列护理干预,A组予常规透析每周2～3次,B组在常规透析基础上,每周予血液灌流1次,比较两组患者治疗前及治疗30周后血清钙（Ca）、磷（P）和血清全段反应性甲状旁腺激素（iPTH）的浓度;观察两组患者皮肤瘙痒、重症肌无力等症状的改善.结果 B组血清iPTH、血磷的下降较A组差异有统计学意义（P＜0.01）;血钙显著上升（P＜0.01）;皮肤瘙痒、重症肌无力等症状明显改善.结论 血液透析联合血液灌流及护理干预可显著降低患者iPTH水平,改善尿毒症继发甲状旁腺功能亢进引起临床症状.     

阿魏酸钠联合尿毒清颗粒治疗慢性肾衰竭54例疗效观察

目的观察阿魏酸钠联合尿毒清颗粒治疗慢性肾衰竭的临床疗效。方法选取在重庆大学医院治疗的110例慢性肾衰竭患者,随机分为治疗组和对照组,两组患者均给予低盐、低磷、优质低蛋白饮食,控制感染,控制血压,维持水电解质、酸碱平衡,糖尿病患者给予胰岛素控制血糖等一般治疗;治疗组在此基础上给予阿魏酸钠和尿毒清颗粒治疗。观察两组患者治疗前后血尿素氮（BUN）、血肌酐（SCr）、肾小球滤过率估计值（eGFR）、血红蛋白（Hbg）、24h尿蛋白定量等变化及临床症状减轻情况。结果治疗组BUN、SCr和24h尿蛋白定量均较治疗前明显下降（P〈0．05）,eGFR较治疗前明显升高（P〈0．05）,且治疗组疗效优于对照组,差异均有统计学意义（P〈O．05）。结论阿魏酸钠与尿毒清颗粒联合治疗能明显改善慢性肾衰竭患者的肾功能损害．具有显著的肾脏保护作用。     

Oxazepam disposition in uremic patients.

The pharmacokinetics of oxazepam was investigated in 13 uremic patients. The apparent terminal half-life of oxazepam in plasma was 24-91 hours compared to 5.9-25 hours reported elsewhere for healthy volunteers. The plasma concentrations showed secondary peaks about 24 hours after the dose and this probably gave rise to the increase in half-life. Plasma clearance of oxazepam appeared to be normal. The conjugated metabolites accumulated to concentrations 5-50 times those of the parent compound and could still be detected 5 days after a single oral dose (0.2 mg/kg). Renal clearance of conjugated oxazepam was significantly correlated to creatinine clearance. The urinary recovery over 5 days was 18-57%. The faecal recovery of 3 days was 0.1-19%. In some patients up to 49% of oxazepam in faeces was in the conjugated form. It is concluded that enterohepatic recycling of oxazepam might occur in uremic patients but is not of great quantitative importance. During multiple dosing the accumulation of conjugates was even more pronounced, with plasma concentrations amounting to 14-61 times those of oxazepam. Steady-state plasma concentrations of oxazepam was similar to those obtained in normal subjects.     

Microbiota-derived uremic retention solutes: perpetrators of altered nonrenal drug clearance in kidney disease

Introduction: Scientific interest in the gut microbiota is increasing due to improved understanding of its implications in human health and disease. In patients with kidney disease, gut microbiota-derived uremic toxins directly contribute to altered nonrenal drug clearance. Microbial imbalances, known as dysbiosis, potentially increase formation of microbiota-derived toxins, and diminished renal clearance leads to toxin accumulation. High concentrations of microbiota-derived toxins such as indoxyl sulfate and p-cresol sulfate perpetrate interactions with drug metabolizing enzymes and transporters, which provides a mechanistic link between increases in drug-related adverse events and dysbiosis in kidney disease.

Areas covered: This review summarizes the effects of microbiota-derived uremic toxins on hepatic phase I and phase II drug metabolizing enzymes and drug transporters. Research articles that tested individual toxins were included. Therapeutic strategies to target microbial toxins are also discussed.

Expert commentary: Large interindividual variability in toxin concentrations may explain some differences in nonrenal clearance of medications. Advances in human microbiome research provide unique opportunities to systematically evaluate the impact of individual and combined microbial toxins on drug metabolism and transport, and to explore microbiota-derived uremic toxins as potential therapeutic targets.     

糖尿病肾病尿毒症患者的血透治疗分析

目的分析糖尿病肾病尿毒症患者的血透治疗效果。方法选取2011年1月1日~2013年12月1日在本院接受血透治疗的糖尿病肾病尿毒症患者和非糖尿病肾病尿毒症患者作为研究对象,各50例,分别纳入A组和B组。比较两组治疗后的生化指标、血透充分性指标、并发症发生情况以及生存情况。结果在生化指标方面,A组肌酐水平(914.63±84.59)μmol/L、血浆白蛋白水平(31.26±4.59)g/L低于B组,血糖水平(9.58±2.15)mmol/L较B组更高(P<0.05),其他三项生化指标比较差异无统计学意义(P>0.05);在血透充分性指标方面,A组尿素清除指数(0.34±0.05)低于B组,单位时间平均尿素浓度(596.36±46.15)mg/L较B组更高(P<0.05),剩余两项指标差别较小(P>0.05);在并发症方面,两组高血压发生率比较接近(P>0.05),但其余并发症发生率均是A组更高(P<0.05);在生存率方面,A组两年和三年生存率均低于B组(P<0.05)。结论血透治疗糖尿病肾病尿毒症的疗效主要受并发症的影响,临床在治疗期间应积极预防并发症,同时采取其他有效措施使疗效提高。     

尿毒清联合川芎嗪注射液治疗慢性肾功能不全的临床观察

目的：通过观察尿毒清联合川芎嗪对慢性肾功能不全患者的疗效,进一步探讨其作用机制。方法：将95例慢性肾功能不全患者随机分为实验组（50例）和对照组（45例）,实验组给予尿毒清联合川芎嗪治疗;对照组给予包醛氧淀粉。观察两组患者治疗前后的临床疗效和血肌酐（Scr）、尿素氮（BUN）、肾小球滤过率（GFR）、血红蛋白（Hb）、红细胞（RBC）等指标。结果：实验组治疗后的总有效率、GFR、Hb和RBC显著高于对照组,BUN、Scr显著低于对照组。结论：尿毒清联合川芎嗪对早、中期慢性肾功能不全患者具有延缓肾衰竭进展、稳定肾功能、改善贫血状态的作用。     

缬沙坦治疗对血液透析患者尿毒症心肌病的影响

目的观察缬沙坦对血液透析患者尿毒症心肌病的影响。方法将维持性血液透析合并尿毒症心肌病患者36例随机分为缬沙坦组19例及对照组17例,分别于透析治疗前、透析3个月后行心脏彩色多普勒检查,测量常规指标左室舒张末径(LVEDD)、收缩功能(EF)及舒张功能(E/A);同时于治疗前后测量血压(BP)、血肌酐(CRE)、甲状旁腺激素(i PTH)、红细胞(RBC)及血红蛋白(HGB)。结果治疗前后2组患者CRE、i PTH、HGB、RBC水平均无显著性变化,差异无统计学意义(P>0.05)。治疗后缬沙坦组患者收缩压、舒张压均明显低于治疗前及对照组(P<0.05),而对照组治疗前后收缩压及舒张压均无明显改变,差异无统计学意义(P>0.05)。对照组治疗前后LVEDD、EF及E/A均无明显改变,差异无统计学意义(P>0.05),而缬沙坦组治疗后LVEDD明显减小,EF明显升高,差异均有统计学意义(P<0.05),但E/A无显著性差异(P>0.05)。缬沙坦组与对照组治疗后比较,LVEDD及EF均有明显改变,差异有统计学意义(P<0.05)。结论缬沙坦有减少尿毒症血液透析患者LVEDD、提高EF,改善心功能的作用。     

尿毒清颗粒致无尿伴双下肢水肿1例

报道尿毒清颗粒新的不良反应,为临床提供安全合理用药。