Drugs In Renal Failure Research Articles

Prescribing drugs in Renal Failure: A Judicious Approach

Prescribing drugs in renal failure is essential to reduce their toxic effects due to unusual accumulation in renal failure. It is because of less protein binding and prolong half life of elimination in case of renal failure. Usually the toxicity of the drug is reduced by either diagnosing serum level of the specific drug or by measuring eGFR of the particular patient. We commonly use three methods in these cases to reduce the side effect of the drugs 1. Interval extension, 2. Dose reduction. 3. Combination of the above two. In case of patients on hemodialysis the drugs which are not protein bound are easily eliminated, so in such cases the drugs are either given after hemodialysis or giving a fraction of the individual dose just after hemodialysis. In case of Renal Transplantation prescribing drugs requires knowledge of the drug-drug interection. It is to be remembered that to get the immediate therapeutic efficacy of the drug in case of renal failure the loading dose is same as that of patients without renal failure, only the maintenance dose is either reduced or given with a prolong interval or both. The following drugs are specially important during prescribing in Renal Failure 1. NSAIDS 2. Psyhotherapeutic drugs 3. Antimicrobials and 4. Cardiovascular Drugs. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 180

Utility, or not, of estimates of glomerular filtration rate in modifying drug dosage, with particular reference to enoxaparin

A reduced clearance of some drugs in renal failure is a problem, particularly with drugs that are excreted by the kidney substantially unmetabolised and also have significant toxicity and a low therapeutic ratio. The problem is compounded by the significant inaccuracy of estimated glomerular filtration rate (eGFR). The aim was to develop general recommendations to reduce the risk of drug toxicity in renal failure, with particular reference to enoxaparin. The substantial inaccuracies in eGFR (eGFR in 32% of patients is different from measured GFR by 20-30%) are compounded when using a dichotomous decision tree (renal failure or not). As the eGFR approaches the GFR decision boundary, for classification as renal failure or not, misclassification approaches 50%. Recommendations, when patients are at risk, include the following: acknowledge inaccuracies of eGFR, particularly in anthropometrically diverse populations; measure drug levels wherever possible; realise that drug levels after early doses relate more to volume of distribution, rather than renal function, allowing time for modification of the drug dose; where accurate urine collection is feasible, use creatinine clearance as an estimate of GFR; and use eGFR as a (more) continuous, rather than dichotomous, variable to adjust dosage, exampled by enoxaparin.

Management of hypertension in hemodialysis patients

Hypertension is very common in patients with chronic kidney disease and is present in most patients with end-stage renal disease (ESRD). Hypertension is largely responsible for premature cardiovascular disease in dialysis patients. The pathophysiology of hypertension in ESRD is complex, and multiple mechanisms are likely involved in blood pressure dysregulation in patients on hemodialysis. Some of these patients demonstrate resistant hypertension. Aggressive control of hypertension in ESRD/dialysis is mandatory. Generally, nonpharmacologic treatments are not enough to achieve the goal blood pressure levels in dialysis patients. Multiple antihypertensive drugs are often necessary. Drugs that block the renin-angiotensin system offer a number of advantages for patients with chronic kidney disease or ESRD, but additional drug classes are often needed to achieve effective blood pressure control in dialysis patients. Physicians treating hypertension in dialysis patients should be familiar with the pharmacokinetic properties of antihypertensive drugs in renal failure and choose the dosages accordingly. Vigorous control of hypertension is recommended to reduce the disease burden in patients with ESRD.

Use of Drugs in Renal Failure in Newborns

Use of Drugs in Renal Failure in Newborns

Antihypertensive Drugs in Renal Failure

Antihypertensive Drugs in Renal Failure

Antihypertensive Drugs in Renal Failure

As a risk factor, arterial hypertension favors the progression of renal failure and promotes cardiovascular complications, leading to early death. Progressive renal failure can be delayed or halted in glomerular diseases, and damage to other end organs can be avoided, by effective measures to lower blood pressure. Calcium antagonists and angiotensin-converting enzyme (ACE) inhibitors appear to be especially suitable as antihypertensive medications, because they may have specific renoprotective properties. Diuretics are required when a volume expansion caused by retention of salt and water occurs in more severe restriction of the glomerular filtrate. After ruling out contraindications and with cautious individualized dosages of antihypertensives (especially ACE inhibitors), deterioration of kidney function resulting from therapy is very rare.

Variability in the renal clearance of cephalexin in experimental renal failure.

This study forms a part of an investigation into the extent to which the type of renal damage influences the renal clearance of drugs. We have already demonstrated an effect of different types of experimental renal failure (ERF) on the renal clearance of two cations: cimetidine, a drug that is filtered and secreted by the nephron, and lithium, which is filtered and reabsorbed by more than one segment of the nephron. In this report the renal clearance of cephalexin (CLCEX) is investigated, a drug that has a different mode of renal elimination, since it is filtered, secreted, and reabsorbed by the proximal tubules. The aim was to extend our earlier studies to an organic anion, and to provide an opportunity to evaluate the feasibility of using the renal clearance of N-1-methylnicotinamide (NMN) to predict the renal clearance of anionic drugs in renal failure. Different models of site-specific ERF have been developed in the rat; proximal tubular necrosis (induced by cisplatin), papillary necrosis (induced by 2-bromoethylamine), and glomerulonephritis (induced by sodium aurothiomalate or by antiglomerular basement membrane antibodies). Glomerular function (GFR) was assessed by the clearance of inulin (CLNULIN), and tubular function was assessed by the clearance of endogenous NMN (CLNMN). OUr results show that even if the models of ERF used were not absolutely site-specific, glomerular function and tubular function did not decrease to the same extent in the different ERF. Therefore, glomerulo-tubular imbalance existed, which is incompatible with the "intact nephron hypothesis," i.e., the site of the damage along the nephron and not only the degree of renal dysfunction, is a potential source of variability in the clearance of certain drugs. The renal clearance of cephalexin was estimated more accurately by CLNMN than GFR (r = 0.90). We conclude that the clearance of the endogenous cation NMN can be used to predict the renal clearance of drugs that are not only filtered by the glomeruli but also secreted and/or reabsorbed by the proximal tubules, and in the limited examples investigated appears to apply to both anionic and cationic compounds. In this respect the GFR alone was not an adequate parameter for the prediction of the renal clearance of such drugs.

The use of drugs in renal failure.

We have tried to emphasize specific variables that impact upon the use of drugs in the patient with renal disease. These variables are complex, often interrelated, and if neglected by the physician will surely lead to unwarranted drug reactions and serious harm to the patient. We have purposely limited the tables of "Selected Pharmacologic Agents" to a few prototypic drugs from each class, emphasizing the newer agents recently introduced in clinical medicine. We strongly recommend that as new drugs are used, the original literature be consulted for verification.

Drugs in renal failure: dosing guidelines for frequently used drugs in end-stage renal disease and dialysis patients.

Drugs in renal failure: dosing guidelines for frequently used drugs in end-stage renal disease and dialysis patients.

Precautions to Take When Using Drugs in Renal Failure?

Precautions to Take When Using Drugs in Renal Failure?

Use of Drugs in Renal Failure

Use of Drugs in Renal Failure

Clinical Pharmacology: An Annotated Bibliography of Recent Literature

Clinical Pharmacology: An Annotated Bibliography of Recent Literature

Binding of drugs in serum, blood cells and tissues of rabbits with experimental acute renal failure.

In vitro binding of phenylbutazone and phenytoin was studied in serum in tissue homogenates, in tissue slices and in blood cells of rabbits with acute renal failure induced by uranyl nitrate. For phenylbutazone serum binding was decreased in uraemic rabbits, while the binding in homogenates of kidneys and liver was increased. For phenytoin binding in serum and in homogenates and slices of kidneys was decreased in uraemic rabbits. Binding of phenylbutazone and phenytoin to blood cells was not significantly changed in uraemic rabbits. The changes in tissue binding found are small and are only significant for liver and kidney which represent a small fraction of total body mass. Although the methodology for measurement of tissue binding is not entirely satisfactory, we think we can conclude that these changes probably contribute only to a minor degree to the increase of the volume of distribution found for these drugs in renal failure as already suggested by our in vivo data in the preceding paper.

The use of drugs in renal failure

In every major class of therapeutic agents certain drugs are excreted primarily by renal mechanisms and dosage adjustments are necessary in the presence of renal failure. Although many agents do not accumulate in the presence of decreased renal function, they may produce untoward effects that are difficult to separate from the side effects of uremia. Knowledge of the dose adjustments of agents noted in this review should aid in prevention of excessive toxic reactions when drugs of various classes are used in the patient with depressed renal function.

Book Review: Clinical Use of Drugs in Renal Failure

Book Review: Clinical Use of Drugs in Renal Failure

Combined seminar on the use of drugs in renal failure : (Stenzel KH, Reidenberg MM, Rubin AL, eds). Am J Med 62: 527–554, 1977

Combined seminar on the use of drugs in renal failure : (Stenzel KH, Reidenberg MM, Rubin AL, eds). Am J Med 62: 527–554, 1977

The biotransformation of drugs in renal failure

Studies of the rates of elimination of drugs normally biotransformed in man have been carried out in uremic patients. Drug oxidations are normal or accelerated. Reduction is slowed. Glucuronide and glycine conjugations are normal whereas acetylation may be normal or slowed. Many hydrolyses are slowed. Thus, the usual dosages of metabolized drugs may have to be altered to properly individualize therapy for patients with renal failure.

Combined seminar on the use of drugs in renal failure: Narcotics, psychotherapeutic agents, antiarrhythmics, antihypertensives, sorbents, vitamin D and its analogues, anabolic hormones and nutritional supplements

The use of drugs in the treatment of patients with renal failure requires a knowledge of excretion, biotransformation and pharmacologic activity of metabolites. Narcotics, analgesics, psychotherapeutic agents, drugs affecting the heart and circulation, various sorbents, resins and gels, anabolic hormones and nutritional supplements are among the more frequently used drugs for patients with end-stage renal disease. Indications and dosages of these drugs must be modified for patients with renal failure, and mechanisms of their biotransformation must be studied. This combined seminar presents the participants' studies and analyses of the problems surrounding the use of these various pharmacologic agents.

The biotransformation of drugs in renal failure : Reidenberg MM: Am J Med 62: 482–485, 1977

The biotransformation of drugs in renal failure : Reidenberg MM: Am J Med 62: 482–485, 1977

Clinical Use of Drugs in Renal Failure.

Clinical Use of Drugs in Renal Failure.