CRF or Renal insufficiency
and overactive bladder
김재헌
Contents
• CRF and overactive bladder
• Renal insufficiency and overactive
bladder
• AM agents
• Clinical trials with vulnerable old patients
Search ((("Kidney Failure, Chronic"[Mesh]) O
R "chronic renal failure"[tiabkw])) AND (("Uri
nary Bladder, Overactive"[Mesh]) OR (("overa
ctive bladder"[tiabkw]) OR "OAB"[tiabkw]))
A total of 4 articles
Search ((("Renal Insufficiency"[Mesh]) OR "re
nal failure"[tiabkw])) AND (("Urinary Bladder,
Overactive"[Mesh]) OR (("overactive bladder"
[tiabkw]) OR "OAB"[tiabkw])))
A total of 13 articles
AM agents
EAU guidelines
Grade
Offer IR or ER formulations of AM agents as initial drug therapy for adults
with UUI
A
If IR formulations of AM agents are unsuccessful for adults with UUI, offer E
R formulations or longer-acting AM agents
A
Consider using transdermal oxybutynin if oral AMs cannot be tolerated due
to dry mouth
B
Offer and encourage early review (efficacy/side effects) of patients on AM a
gents for UUI (<30 d)
A
Use AM agents with caution in patients with cognitive dysfunction
B
Clinical Trials for Vulnerable elderly: Fesoterodine
Flexible-dose fesoterodine in elderly adults with overactive bladder:
results of the randomized, double-blind, placebo-controlled study
of fesoterodine in an aging population trial.
J Am Geriatr Soc. 2013 Feb;61(2):185-93.
Long-term safety, tolerability and efficacy of flexibledose fesoterodine in elderly patients with overactive bladder: openlabel extension of the SOFIA trial.
Neurourol Urodyn. 2014 Jan;33(1):106-14.
Effect of fesoterodine in vulnerable elderly subjects with urgency
incontinence: a double-blind, placebo controlled trial.
J Urol. 2014 Feb;191(2):395-404.
Clinical Trials for Vulnerable elderly: Solifenacin
Anticholinergics have a small, but significant, effect on
urinary leakage in older adults with UUI.
Treatment with drugs for UUI in the frail elderly is not
evidence based
Pharmacokinetics in renal Impairment: fesoterodine
Pharmacokinetics in renal Impairment: fesoterodine
• Increased renal impairment did not affect the
terminal half-life of 5-HMT following
administration of sustained-release fesoterodine.
• Increase in accumulation at steady state was not
expected.
• Furthermore, given the involvement of renal and
Multiple metabolic pathways in the elimination
of 5-HMT, only modest increases in exposure
were seen attributable to changes in renal
impairment.
Pharmacokinetics in renal Impairment: solifenacin
Patients with severe renal impairment
should receive no more than 5 mg
solifenacin once daily
Pubmed (850) + EMBASE (990) + Cochrane (10) = 1850
Duplication (831)
=> Pubmed (438) +EMBASE (984) + Cochrane (10) =1432