| [ Summary ] |
Alzheimer's disease is one of the most common causes of dementia in the elderly, characterized by cognitive dysfunction, deterioration in daily living activities, and the presence of psychiatric symptoms. The new-generation acetylcholinesterase inhibitor, donepezil, improves memory and cognitive function in patients with mild to moderate Alzheimer's disease. Pharmacokinetic analysis has shown that this agent is metabolized in the liver and primarily eliminated by renal excretion rather than biliary excretion in humans. Therefore, patients with impaired renal functions could be at high risk for toxicity caused by accumulation of this agent. However, there was no toxicity or adverse effect from donepezil in patients with renal insufficiency when treating chronic dialysis patients because this drug's pharmacokinetics did not change in those patients. Atypical anti-psychotics agents, including quetiapine, risperidone and olanzapine may have beneficial effects on psychotic symptoms and behavioral abnormalities in patients with Alzheimer's disease and renal dysfunction.
Cerebrovascular disorders are among the major complications in patients undergoing haemodialysis. The thromboxane A2 synthetase inhibitor, sodium ozagrel, improves global neurological function in brain infarction patients. Argatroban is a direct thrombin inhibitor and provides adequate anticoagulation to enable successful treatment of brain infarctions. In patients with renal dysfunction, however, the use of these agents is hampered by the absence of reliable pharmacokinetic or clinical trial data. In the treatment of patients with advanced renal insufficiency and cerebrovascular disorders, these agents should be used with dose modification to account for altered excretion. Edarabon, a free radical scavenger, is an important tool in the management of most cerebrovascular disorders. As the use of this agent was sometimes accompanied by adverse reactions related to acute renal failure, patients with cerebrovascular disorders compromising renal sufficiency, are prohibited from receiving treatment with edarabon. |