Pharmacology and the Kidney

  • Caroline Ashley


The kidney plays an important role in the handling of drugs in the body; therefore patients with renal impairment will invariably require different dosage regimes to those with normal renal function. Unfortunately, there are no absolute guidelines on how to adjust doses in renal impairment, and pharmaceutical company literature often excludes patients with renal impairment in the dosage guidelines. Where information can be found, the advice may not be specific and different texts may give different advice [2]. Therefore, it is important to have an understanding of the potential effects of renal impairment on the pharmacodynamic and pharmacokinetic properties of a drug so that appropriate dosing decisions can be made. Although a reduced GFR is the primary reason for reduced excretion of drugs in renal failure, absorption, distribution, protein binding, metabolism and pharmacodynamics are all relevant.


Chronic Kidney Disease Renal Impairment Renal Replacement Therapy Unbind Drug Serum Albumin Concentration 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Gabardi S, Abramson S. Drug dosing in chronic kidney disease. Med Clin North Am. 2005;89(3):649–87.PubMedCrossRefGoogle Scholar
  2. 2.
    Cockwell P, Stringer S, Marriott J. Acute kidney injury. In: Walker R, editor. Clinical pharmacy and therapeutics. 5th ed. London: Churchill Livingstone; 2011. p. 255–71.Google Scholar
  3. 3.
    Dhillon S, Kostrzewski A. Clinical pharmacokinetics. London: Pharmaceutical Press; 2006. p. 53–78.Google Scholar
  4. 4.
    Matzke GR, Frye RF. Drug administration in patients with renal insufficiency: minimising renal and extrarenal toxicity. Drug Saf. 1997;16(3):205–31.PubMedCrossRefGoogle Scholar
  5. 5.
    Aronson JK. Drugs and renal insufficiency. Medicine. 2007;35:396–9.CrossRefGoogle Scholar
  6. 6.
    Bauer L. Creatinine clearance versus glomerular filtration rate for the use of renal drug dosing in patients with kidney dysfunction. Pharmacotherapy. 2005;25(9):1286–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Thompson CA. Better renal-function estimates not expected to alter drug dosing right away. Am J Health Syst Pharm. 2005;62(23):2442–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Vidal L, Shavit M, Fraser A, et al. Systematic comparison of four sources of drug information regarding adjustment of dose for renal function. Br Med J. 2005;331:263–6.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Department of PharmacyRoyal Free London NHS Foundation TrustHampstead, LondonUK

Personalised recommendations