Safe Drug Use in The Elderly With Kidney Disease Is The First Priority

The medication of elderly patients with kidney disease should not only consider the physiological changes brought about by the aging of the body, but also consider the changes in the function of the kidney, which is the main organ for excreting drugs from the body. Pay attention to the following points when taking medication:

Pay attention to drug properties

First of all, it is necessary to understand the pharmacokinetic properties of drugs. For example, drugs that are mainly excreted by the kidneys in their original form or metabolites are easy to accumulate in the body and cause poisoning, so they need to be used in reduced doses. Some drugs, such as doxycycline, are mainly excreted in feces after oral administration, and patients with kidney disease will not cause accumulation in the body when they are taken orally, so there is no need to adjust the dose. Sulfonamides can form crystals in the urinary tract and easily lead to urinary tract obstruction and worsen renal function, so they should be avoided.

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Secondly, it is necessary to understand the potential side effects of drugs, such as neomycin, gentamicin, amikacin, tobramycin, streptomycin, and some cephalosporins, polymyxins, vancomycin, Amphotericin B, and other antibiotics, these drugs have certain nephrotoxicity, patients with nephropathy should be used with caution, and the dose should be adjusted when necessary.

Although some drugs themselves have no nephrotoxicity, they can also cause kidney damage because the patient is allergic to these drugs. For example, new penicillin can cause acute allergic interstitial nephritis, which is manifested as fever, rash, eosinophilia, oliguria, and renal failure. Functional decline, etc., also needs to be used with caution.

There are also commonly used cold medicines and analgesics. If used for a long time, they can inhibit the enzyme activity of renal tubular cells, produce direct renal tubular toxicity, and sometimes cause allergic reactions in renal tissues. Such drugs should also be used with caution.

Pay attention to the dosage

With the aging of the body, the functions of various organ systems of the elderly will decline significantly. The gastrointestinal function is poor, and it is easy to cause gastrointestinal reactions after taking the medicine. The activity of the liver's drug metabolism and decomposing enzymes is reduced, and the ability to catabolize the drug is reduced. The potency of the drug is significantly reduced which eventually leads to the accumulation of the drug in the body.

Therefore, care should be taken to adjust the dose of medication for elderly patients with kidney disease. It is advisable to start with a small dose and gradually adjust it according to the curative effect. Adjustment of drug dose can be carried out in the following two ways: 1. Reduce the daily or each dose, and the number of administrations remains unchanged. 2. Prolong the administration time, and keep the same dosage for each administration.

For those drugs with strong effects, large reactions, and small safety ranges, such as aminophylline and cardiac glycosides, the dosage adjustment should be particularly cautious. When conditions permit, it is best to monitor the blood drug concentration and adjust the drug dosage accordingly adjustment. All drugs should not be used for too long and should be stopped in time when the curative effect is achieved.

Pay attention to the type of medication

Minimize the types of medications, generally within four, reduce the combination of drugs with similar types, effects, and side effects, and use long-acting preparations as much as possible to reduce the number of medications. Since most drugs are excreted by the kidneys, for elderly patients with kidney disease, using too many types and quantities of drugs will not only aggravate kidney damage but may also lead to more drug interactions due to drug accumulation.

In old age, the decline of liver function leads to the weakening of drug intake, metabolism, and detoxification. The decline of renal function and kidney disease accompanied by aging leads to a slowdown of drug excretion through the kidney and a decrease in the amount of excretion, which can eventually make various drugs in the body. The half-life is extended to varying degrees, such as aminoglycoside antibiotics excreted from the kidneys, which can be extended to more than twice the normal amount.

The level of plasma protein in elderly patients with kidney disease is low, and the binding rate of drugs and plasma proteins decreases, increasing the free concentration of drugs in the blood. The above factors have jointly led to enhanced drug efficacy and prolonged maintenance time, and are prone to toxic and side effects.

Elderly patients with kidney disease, especially those with other chronic underlying diseases, such as chronic hepatitis, liver cirrhosis, hypertension, diabetes, and hypoalbuminemia, have more serious adverse drug reactions and consequences. During medication, drug side effects must be closely observed. Discontinue the drug in time when serious side effects occur.

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