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Int. J. Mol. Sci. 2014, 15(2), 2538-2553; doi:10.3390/ijms15022538

Xenobiotic Metabolism: The Effect of Acute Kidney Injury on Non-Renal Drug Clearance and Hepatic Drug Metabolism

1
General Intensive Care Unit, St. George's Hospital, London SW17 0QT, UK
2
Division of Clinical Sciences, St. George's, University of London, London SW17 0RE, UK
3
Renal Medicine, St. George's Hospital, London SW17 0QT, UK
*
Author to whom correspondence should be addressed.
Received: 9 December 2013 / Revised: 12 December 2013 / Accepted: 27 December 2013 / Published: 13 February 2014
(This article belongs to the Special Issue Xenobiotic Metabolism)
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Abstract

Acute kidney injury (AKI) is a common complication of critical illness, and evidence is emerging that suggests AKI disrupts the function of other organs. It is a recognized phenomenon that patients with chronic kidney disease (CKD) have reduced hepatic metabolism of drugs, via the cytochrome P450 (CYP) enzyme group, and drug dosing guidelines in AKI are often extrapolated from data obtained from patients with CKD. This approach, however, is flawed because several confounding factors exist in AKI. The data from animal studies investigating the effects of AKI on CYP activity are conflicting, although the results of the majority do suggest that AKI impairs hepatic CYP activity. More recently, human study data have also demonstrated decreased CYP activity associated with AKI, in particular the CYP3A subtypes. Furthermore, preliminary data suggest that patients expressing the functional allele variant CYP3A5*1 may be protected from the deleterious effects of AKI when compared with patients homozygous for the variant CYP3A5*3, which codes for a non-functional protein. In conclusion, there is a need to individualize drug prescribing, particularly for the more sick and vulnerable patients, but this needs to be explored in greater depth. View Full-Text
Keywords: acute kidney injury; cytochrome P450; drug metabolism; pharmacogenetics; pharmacokinetics; CYP3A acute kidney injury; cytochrome P450; drug metabolism; pharmacogenetics; pharmacokinetics; CYP3A
This is an open access article distributed under the Creative Commons Attribution License (CC BY 3.0).

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MDPI and ACS Style

Dixon, J.; Lane, K.; MacPhee, I.; Philips, B. Xenobiotic Metabolism: The Effect of Acute Kidney Injury on Non-Renal Drug Clearance and Hepatic Drug Metabolism. Int. J. Mol. Sci. 2014, 15, 2538-2553.

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