Drug Prescription in Chronic Kidney Disease

Chapter

Abstract

Selection of drugs and their dosing in patients with CKD is a challenging but unavoidable task as the number of patients suffering from CKD is increasing worldwide and exceeds 15 % of the population in industrialized countries. In the United States 62.2 % of subjects ≥80 years have an eGFR <60 ml/min. As the most prevalent underlying diseases leading to CKD are diabetes and hypertension, drugs treating both conditions are of particular importance. CKD per se also increases the risk of cardiovascular events, cancer, and infections; hence, adequate and intensified pharmacotherapy is of utmost importance in this patient population. About 60 % of all routinely used drugs are excreted by the kidney. If GFR decreases below 60 ml/min and more than 50 % of the drug is eliminated via the kidney, dose adjustment is necessary to avoid untoward effects and serious complications. Moreover, some drugs although not renally excreted, bear the potential for severe kidney damage and should therefore not be administered at all in CKD patients, such as NSAIDs.

The first important step for dose adjustment is the accurate estimation of kidney function, i.e., GFR. In case of CKD5D, i.e., patients undergoing chronic maintenance dialysis, the influence of renal replacement therapies that vary in modality (hemodialysis, peritoneal dialysis) and intensity (thrice weekly dialysis, daily dialysis, nocturnal dialysis) has to be taken into account additionally.

Keywords

Proteinuria Vancomycin Etoposide Carboplatin Gabapentin 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
  2. 2.Abteilung für Nieren- und HochdruckerkrankungenMedizinische Hochschule HannoverHannoverGermany

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