• Vol. 38 No. 12, 1095–1103
  • 15 December 2009

Drug Use and Dosing in Chronic Kidney Disease

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ABSTRACT

One of the most important drug-related problems in patients with chronic kidney disease (CKD) is medication dosing errors. Many medications and their metabolites are eliminated through the kidney. Thus, adequate renal function is important to avoid toxicity. Patients with renal impairment often have alterations in their pharmacokinetic and pharmacodynamic parameters. The clearance of drugs eliminated primarily by renal fi ltration is decreased by renal disease. Therefore, special consideration should be taken when these drugs are prescribed to patients with impaired renal function. Despite the importance of dosage adjustment in patients with CKD, such adjustments are sometimes ignored. Physicians and pharmacists can work together to accomplish safe drug prescribing. This task can be complex and require a stepwise approach to ensure effectiveness, minimise further damage and prevent drug nephrotoxicity.


Chronic kidney disease (CKD) is an important therapeutic problem. There is an increasing realisation that renal impairment is under-diagnosed, and this has led to attempts to improve both the detection and management of patients with impaired renal function.1 The Kidney Disease Outcomes Quality Initiative (K/DOQI) of the National Kidney Foundation established a classification of CKD that has been accepted and used worldwide. This classification defines CKD as a Glomerular filtration rate (GFR) <60 mL/min/1.73 m² or a GFR ≥60 mL/min/1.73 m² together with the presence of kidney damage for more than 3 months. Based on this definition, the K/DOQI has recommended a classification of CKD that is divided into 5 stages (Table 1).2

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