What Do We Know About Steroids Metabolism and ‘PK/PD Approach' in AKI and CKD Especially While on RRT - Current Status in 2014
| Autor: | Herbert D. Spapen, Jouke De Regt, Thomas Rose, Willem Boer, Rita Jacobs, Elisabeth De Waele, Patrick M. Honore, Viola Van Gorp, Olivier Joannes-Boyau |
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| Přispěvatelé: | Brussels Heritage Lab, Supporting clinical sciences, Intensive Care, Internal Medicine Specializations, Research Group Critical Care and Cerebral Resuscitation |
| Rok vydání: | 2014 |
| Předmět: |
Hydrocortisone
Acute Kidney Injury/blood medicine.medical_treatment Blood Proteins/metabolism Methylprednisolone/blood Pharmacology Hydrocortisone/blood Methylprednisolone Dexamethasone Steroid Pharmacokinetics Prednisone medicine Humans Drug Dosage Calculations Renal replacement therapy Renal Insufficiency Chronic Dialysis PK/PD models Dexamethasone/blood business.industry Blood Proteins Hematology General Medicine Acute Kidney Injury Nephrology Free fraction Prednisolone Renal Insufficiency Chronic/blood business Prednisone/blood renal replacement therapy Protein Binding medicine.drug |
| Zdroj: | Blood Purification. 38:154-157 |
| ISSN: | 1421-9735 0253-5068 |
| DOI: | 10.1159/000368390 |
| Popis: | The knowledge on PK behavior of steroid drugs such as prednisolone or prednisone has indeed been expanding but at a rather slow pace. First, convenient, rapid, and specific determination of plasma levels of these steroids was largely indebted to the breakthrough of high performance liquid chromatography (HPLC). Second, prednisolone is non-linearly protein-bound. Since unbound prednisolone is the biologically active compound, only the measurement of this free fraction in plasma is relevant. Third, the short half-life of prednisolone precludes to reach steady-state levels and requires determination of the area under the concentration-time curve. Fourth, prednisolone and prednisone are mutually convertible. Intravenous prednisolone, however, is administered as a pro-drug ester, which renders comparison and interpretation of reported PK data of both agents unreliable. A poignant lack of awareness and knowledge regarding catabolism, clearance mechanisms, and elimination route of steroids fuels the ongoing controversy that surrounds adjunctive corticosteroid therapy in patients with chronic or acute inflammatory disease. This particular patient population is also more prone to develop early and significant kidney dysfunction, necessitating extra-renal support. A better understanding of steroid PK/PD, preferentially guided by HPLC measurement of plasma steroid concentrations, likely will have direct clinical implications, for instance by adapting steroid doses in IHD or implementing higher dose regimens during CRRT. |
| Databáze: | OpenAIRE |
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