Abstract：
Patients receiving hemodialysis (HD) often develop gastrointestinal diseases. Recently, although in general population, clinical guidelines for Helicobacter pylori have strongly recommended its eradication in patients to prevent gastric cancer, optimal eradication regimen and optimal dosage of drugs for patients receiving HD have not been established, due to possible incidence of adverse events. Some antimicrobial agents used in eradication therapy, particularly amoxicillin, can exacerbate renal dysfunction. Given the delayed pharmacokinetics of drugs in patients receiving HD compared with those in healthy individuals, drug regimen and dosage should be considered to minimize adverse effects. Although previous studies have investigated the benefits of eradication therapy for patients receiving HD, because most studies were small in terms of the number of enrolled patients, it is hard to show evidence. The numbers of eradication in HD patients have recently increased, and it is important to provide an optimal regimen. The consideration of eradication in patients undergoing HD with a reduction in the drug dose by 1/2-1/3 may prevent adverse events. Additionally, another important consideration is whether adverse events can be prevented while maintaining a similar eradication rate with reduced drug dosages. Recent meta-analysis findings indicate comparable eradication rates in patients receiving HD and healthy individuals, both with the same dosage regimen and at a reduced dosage regimen, with no significant differences (relative risk [RR] for successful eradication: 0.85 [95% confidence interval (CI): 0.48-1.50]). Unlike with the same dosage regimen (RR for adverse events: 3.15 [95% CI: 1.93-5.13]), the adverse events in the dosage reduction regimen were similar to those in healthy individuals (RR: 1.26 [95% CI: 0.23-6.99]). From a pharmacological perspective, the eradication regimen in patients receiving HD should consider the dosage (1/2-1/3 dosage), dosing number (bid), dosing timing of drugs (after HD), and susceptibility to antimicrobial agents.
摘要：
接受血液透析（HD）的患者经常发生胃肠道疾病。最近,虽然在一般人群中，幽门螺杆菌的临床指南强烈建议在患者中根除幽门螺杆菌以预防胃癌，尚未确定接受HD的患者的最佳根除方案和最佳药物剂量，由于不良事件的可能发生率。一些用于根除治疗的抗菌剂，尤其是阿莫西林,会加剧肾功能障碍。鉴于与健康个体相比，接受HD的患者中药物的药代动力学延迟，应考虑药物方案和剂量，以尽量减少不良反应。尽管以前的研究已经调查了根除治疗对接受HD患者的益处，因为大多数研究的登记患者数量很少，很难拿出证据。最近HD患者的根除人数有所增加，提供最佳方案是很重要的。考虑在HD患者中根除药物剂量减少1/2-1/3可以预防不良事件。此外,另一个重要的考虑因素是,在减少药物剂量的情况下,是否可以预防不良事件,同时保持相似的根除率.最近的荟萃分析结果表明，接受HD的患者和健康个体的根除率具有可比性。使用相同的剂量方案和减少的剂量方案，没有显着差异（成功根除的相对风险[RR]：0.85[95％置信区间（CI）：0.48-1.50]）。与相同剂量方案不同（不良事件的RR：3.15[95％CI：1.93-5.13]），减量方案的不良事件与健康个体相似(RR:1.26[95%CI:0.23~6.99]).从药理学的角度来看，接受HD的患者的根除方案应考虑剂量（1/2-1/3剂量），给药编号（投标），药物的给药时间（HD后），和对抗菌剂的敏感性。
