Kidney medication
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Kidney Medication: Insights and Challenges
Medication Nonadherence in Kidney Transplant Recipients
Keywords: kidney transplant, medication nonadherence, immunosuppressive therapy
Medication nonadherence is a significant challenge in kidney transplant recipients, impacting long-term graft survival. Lifelong immunosuppressive therapy is essential to prevent alloimmunity, but nonadherence is common and often begins early post-transplant, though its effects may be delayed. Key risk factors for nonadherence include past nonadherence, being an adolescent or young adult, minority race/ethnicity, poor social support, and poor perceived health. In children, parental and child psychological and behavioral issues, as well as parental distress, also play a role. Tailored interventions addressing individual needs and barriers are crucial, yet few effective interventions have been studied comprehensively.
Interventions to Improve Medication Adherence
Keywords: medication adherence, kidney transplant, intervention strategies
Improving medication adherence in kidney transplant recipients requires multifaceted approaches. Effective interventions often combine educational, behavioral, psychological, and financial support. Studies show that multidimensional interventions significantly enhance adherence, whereas single interventions like nurse feedback or financial aid alone are less effective. Tools like dose administration aids, when paired with self-monitoring, also improve adherence. However, developing and testing these interventions remains complex due to the intricate medication regimens involved.
Drug Repurposing in Kidney Disease
Keywords: drug repurposing, kidney disease, chronic kidney disease
Drug repurposing offers a promising avenue for treating kidney diseases, leveraging existing medications for new clinical indications. This approach is cost-effective and benefits from known safety profiles. For chronic kidney disease (CKD), particularly diabetic kidney disease, drugs like sodium glucose co-transporter 2 inhibitors and glucagon-like peptide 1 agonists show potential for renal protection beyond their glucose-lowering effects. Other candidates include xanthine oxidase inhibitors, endothelin receptor antagonists, and Janus kinase inhibitors, which may offer cardiovascular and renal benefits.
Pharmacotherapy in Acute Kidney Injury and Chronic Kidney Disease
Keywords: acute kidney injury, chronic kidney disease, pharmacotherapy
Managing medications in patients with acute kidney injury (AKI) and CKD is complex due to altered pharmacokinetics and pharmacodynamics. Continuous renal replacement therapy (CRRT) in critically ill patients necessitates careful drug dosing to avoid toxicity. For CKD patients, appropriate pharmacotherapy can slow disease progression and reduce morbidity and mortality, but requires careful adjustment based on renal function. This includes considering drug interactions, potential nephrotoxicity, and individualizing therapy to optimize outcomes.
Comparative Effects of Glucose-Lowering Medications on Kidney Outcomes
Keywords: type 2 diabetes, glucose-lowering medications, kidney outcomes
In type 2 diabetes (T2D), which is a leading cause of kidney disease, the choice of glucose-lowering medications can impact kidney function. The GRADE trial compared the effects of adding insulin glargine, glimepiride, liraglutide, or sitagliptin to metformin in T2D patients. Over five years, no significant differences in kidney outcomes were observed among the different medication classes, suggesting that these medications are similarly effective in managing glycemic control without adverse kidney effects.
Temporary Discontinuation of Medications to Prevent Acute Kidney Injury
Keywords: acute kidney injury, medication discontinuation, risk management
Temporary discontinuation of certain medications, such as ACE inhibitors and ARBs, may reduce the risk of AKI in specific clinical settings like coronary angiography and cardiac surgery. However, evidence is limited and primarily hospital-based, with no studies evaluating discontinuation during intercurrent illnesses in community settings. The potential benefits of discontinuation must be weighed against the risks, and more research is needed to guide clinical practice.
Conclusion
Effective management of kidney medication involves addressing nonadherence, leveraging drug repurposing, and carefully adjusting pharmacotherapy based on individual patient needs. Multifaceted interventions and tailored approaches are essential for improving medication adherence in kidney transplant recipients. Drug repurposing offers new therapeutic possibilities for CKD, while careful pharmacotherapy management is crucial for both AKI and CKD patients. Understanding the comparative effects of glucose-lowering medications and the potential benefits of temporary medication discontinuation can further enhance patient outcomes.
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