Contents

Disclaimer

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Show Summary Details
Page of

Drugs and the kidney 

Drugs and the kidney
Chapter:
Drugs and the kidney
Author(s):

Aine Burns

, and Caroline Ashley

DOI:
10.1093/med/9780198746690.003.0509
Page of

PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2021. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

date: 25 February 2021

The kidney plays a critical role in the elimination of many drugs from the body, hence consideration should be given to a patient’s renal function whenever any drug is prescribed. Much kidney disease is unrecognized, but the widespread reporting of estimated glomerular filtration rates (eGFR) has brought greater awareness of the prevalence of chronic kidney disease (CKD), thereby encouraging medical practitioners to take account of reduced renal function when prescribing. CKD is very often one of many coexisting comorbid conditions, especially in elderly patients, when particularly careful thought must be given to appropriate drug dosing and the possibility of drug interactions. A reduced GFR is the primary reason for reduced excretion of drugs in renal failure, but drug absorption, distribution, protein binding, metabolism, and pharmacodynamics may all be affected. Key general points—both filtration and secretion of drugs appear to fall in parallel and in proportion to the GFR. The clinical significance of a reduction in GFR and increased drug half-life depends on the relative importance of renal excretion and metabolism as a mode of elimination, and the therapeutic ratio of the drug. If nonrenal clearance accounts for elimination of more than 50% of a drug, then no adjustment needs be made to dose/frequency of administration. Dosages of drugs which are mainly excreted in active form by the kidney may need to be modified to avoid accumulation. Potentially toxic drugs should only be used in patients with renal failure if there is a specific indication for their use and if therapy can be monitored appropriately. If dose adjustment is required, then dose, dose interval, or both can be adjusted to achieve the desired therapeutic profile.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.