Читать книгу Clinical Pharmacology and Therapeutics - Группа авторов - Страница 57

The following changes occur in patients with impaired renal function:

1 Acidic drugs are less bound to serum albumin and the decrease in binding correlates with the severity of renal impairment. The binding of basic drugs (to α1‐acid glycoprotein) undergoes little or no change

2 The structure of albumin is changed in renal failure and endogenous compounds may compete with drugs for binding

3 Haemodialysis does not return binding to normal, but renal transplantation does.

In most cases, changes in protein binding have limited clinical relevance and do not require alterations in dose. However, protein binding is important for the interpretation of serum phenytoin concentrations.