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Kidney Int. 2014 Mar;85(3):522-8. doi: 10.1038/ki.2013.399. Epub 2013 Oct 16.

Effects of chronic kidney disease and uremia on hepatic drug metabolism and transport.

Author information

1
1] Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA [2] Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington, USA.
2
1] Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington, USA [2] Department of Pharmaceutics, School of Pharmacy, University of Washington, Seattle, Washington, USA.
3
Department of Pharmaceutics, School of Pharmacy, University of Washington, Seattle, Washington, USA.
4
Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington, USA.

Abstract

The pharmacokinetics of non-renally cleared drugs in patients with chronic kidney disease is often unpredictable. Some of this variability may be due to alterations in the expression and activity of extra renal drug-metabolizing enzymes and transporters, primarily localized in the liver and intestine. Studies conducted in rodent models of renal failure have shown decreased mRNA and protein expression of many members of the cytochrome P450 enzyme (CYP) gene family and the ATP-binding cassette (ABC) and solute carrier (SLC) gene families of drug transporters. Uremic toxins interfere with transcriptional activation, cause downregulation of gene expression mediated by proinflammatory cytokines, and directly inhibit the activity of the cytochrome P450s and drug transporters. While much has been learned about the effects of kidney disease on non-renal drug disposition, important questions remain regarding the mechanisms of these effects, as well as the interplay between drug-metabolizing enzymes and drug transporters in the uremic milieu. In this review, we have highlighted the existing gaps in our knowledge and understanding of the impact of chronic kidney disease on non-renal drug clearance, and identified areas of opportunity for future research.

PMID:
24132209
PMCID:
PMC4276411
DOI:
10.1038/ki.2013.399
[Indexed for MEDLINE]
Free PMC Article

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