Interní Med. 2010; 12(1): 18-21

Drug therapy in patients with impaired renal function

MUDr.Jan Vachek, prof.MUDr.Vladimír Tesař, DrSc.

Klinika nefrologie VFN, Praha

Patients with chronic kidney disease (CKD) are more threatened by drug adverse effects and interactions. Pathophysiological changes

caused by CKD influence many pharmacokinetics properties, resulting in diminished glomerural filtration rate (GF) and altered tubular

secretion and reabsorbtion. Before setting a patient on a new drug, next scheme is recommended: estimating renal functions (preferably

creatinine clearance), evaluation of drug clearance and estimating initial and maintenance dose, checking of plasma level, and

dose revision, if appropriate. In renal-excreted drugs, dosing scheme may be adjusted by dose reducing, interval prolongation or both.

Choosing a suitable drug in dialysed patients is a common problem. It is neccessary to consider binding to plasma albumin, molecular

weight as well as many further aspects, e.g. determined by anuria and consequent need of water restriction. Selection of a suitable drug

and adequate dosing is essential for preventing adverse effects and obtaining optimal therapeutic effect.

Keywords: drug therapy, pharmacokinetics, renal function, chronic kidney disease, hemodialysis, glomerular filtration rate

Published: May 1, 2010  Show citation