Renal Drug Dosing References

Introduction

Individualization of a drug dosage regimen for a patient with impaired kidney function is based on

• the pharmacodynamic/pharmacokinetic characteristics of the drug,
• the patient's degree of residual renal function, and
• the patient's overall clinical condition.

For drugs primarily removed by the kidneys, common methods of dose adjustment include:

• Reducing the dose while maintaining the common dosing interval
• Maintaining the dose while extending the dosing interval, or
• A combination of both

Standard References

In addition to the product leaflet, most pharmacists may also consider consulting these standard references when determining renal dosage adjustments for CKD patients.

• AHFS Drug Information
• Australian Medicines Handbook
• British National Formulary
• Micromedex
• Lexicomp
• Medscape

Aronoff's Drug Prescribing in Renal Failure, 2007

Drug Prescribing in Renal Failure focuses on drug dosing in patients with impaired kidney function. The information takes the form of a "Recommendation Level" and is added to the columns "Adjustment for Renal Failure" and "Supplement for Dialysis" as follows.

• A - Recommendations derived from human trials larger than a case study
• B - Recommendations derived from human case study
• C - Recommendations derived from in vitro data
• D - Recommendations derived from the authors' educated assessment based on the pharmacokinetics and pharmacodynamics of the drug

However, this book is last updated in 2007 and hence, newer evidence and drugs may not be included.

Demystifying Drug Dosing in Renal Dysfunction, 2019

Demystifying Drug Dosing in Renal Dysfunction serves as a quick reference for commonly used medication dosing given varying degrees of renal dysfunction and/or use of renal replacement modalities.

• Data are presented to allow the practitioner to understand the nuances considered when developing the dosing recommendations.

The Renal Drug Handbook, 2019

The Renal Drug Handbook is an invaluable guide in which the information has been compiled from a wide range of sources and from the clinical experience of the UK Renal Pharmacy Group.

• It provides detailed drug information (over 900 drug monographs) to assist healthcare professionals to safely dose medications in patients with kidney disease.

Renal Pharmacotherapy, 2021

Renal Pharmacotherapy is a comprehensive listing of dosage recommendations of systemic medications for adult patients with compromised renal function.

• This document was originally designed for use by those who are competent healthcare professionals employed by or directly connected and having privileges with the University of Colorado Hospital who rely on their clinical judgement and discretion.

Summary

Renal dosage adjustments are typically based on a combination of pharmacokinetic principles and real-life studies.

• Consequently, similar to pediatric dosing, recommendations from different drug information sources can exhibit significant variability.