Medication in Chronic Kidney Disease

  • Hongdi CaoEmail author


Chronic kidney disease (CKD) is a common disorder that is associated with multiple comorbidities and complications. The evidence for medications in patients with CKD is still insufficient. Several factors should be considered when different medications were selected in patients with CKD, such as the altered drug absorption and distribution. Because most pharmacokinetic data are collected from the trials which usually do not include patients with CKD, the evidence and the guidelines for the treatment of a general population might not be suitable for patients with CKD. Commonly used medicines in patients with CKD such as adrenal glucocorticoids, immunosuppressants, diuretics, inhibitors of the renin-angiotensin-aldosterone system, anticoagulation agents, antibacterial agents, and traditional Chinese medicines are described. Patients with CKD often need multiple medications for treatment of complications, and most drugs are excreted through the kidneys of a prototype or metabolite, thus most therapies should be adjusted according to renal function to avoid side effects of drug accumulation.


  1. 1.
    Velenosi TJ, Urquhart BL. Pharmacokinetic considerations in chronic kidney disease and patients requiring dialysis. Expert Opin Drug Metab Toxicol. 2014;10(8):1131–43.CrossRefGoogle Scholar
  2. 2.
    Long B, Koyfman A, Lee CM. Emergency medicine evaluation and management of the end stage renal disease patient. Am J Emerg Med. 2017;35(12):1946–55.CrossRefGoogle Scholar
  3. 3.
    Weir MR, Fink JC. Safety of medical therapy in patients with chronic kidney disease and end-stage renal disease. Curr Opin Nephrol Hypertens. 2014;23(3):306–13.CrossRefGoogle Scholar
  4. 4.
    Coca SG, Krumholz HM, Garg AX, Parikh CR. Underrepresentation of renal disease in randomized controlled trials of cardiovascular disease. JAMA. 2006;296(11):1377–84.CrossRefGoogle Scholar
  5. 5.
    Kuang D, Verbine A, Ronco C. Pharmacokinetics and antimicrobial dosing adjustment in critically ill patients during continuous renal replacement therapy. Clin Nephrol. 2007;67(5):267–84.CrossRefGoogle Scholar
  6. 6.
    Fink JC, Chertow GM. Medication errors in chronic kidney disease: one piece in the patient safety puzzle. Kidney Int. 2009;76(11):1123–5.CrossRefGoogle Scholar
  7. 7.
    Dreisbach AW. The influence of chronic renal failure on drug metabolism and transport. Clin Pharmacol Ther. 2009;86(5):553–6.CrossRefGoogle Scholar
  8. 8.
    Liles AM. Medication considerations for patients with chronic kidney disease who are not yet on dialysis. Nephrol Nurs J. 2011;38(3):263–70.PubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.Centre for Kidney DiseaseSecond Affiliated Hospital, Nanjing Medical UniversityNanjingChina

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