Calculation of Drug Dosage In Chronic Kidney Disease

Tenta Hartian Hendyatama, Nunuk Mardiana

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Kidneys are the main organ in fluid and electrolyte homeostasis. It also have an important role in eliminating various types of drugs. Drug elimination in the kidney is affected by plasma drug concentrations, plasma protein binding, and kidney function. Glomerular filtration rate (GFR) represents the kidney function. Thus by knowing it, drug dosage can be determined.

Chronic kidney disease alter the effect of drug, some decrease drug effect but more often increase drug toxicity. Chronic kidney disease affect the pharmacodynamic and pharmacokinetic of drug. Therefore, providing an optimal treatment for CKD patient, knowledge of the pharmacokinetic and pharmacodynamic changing in CKD is needed.

Exploring the patient's history and carrying out complete physical examination is important before giving the drug to patients with impaired kidney function. In addition, identifying drugs that have the potential to cause nephrotoxicity and drug interactions is also important.

The body response to drugs in patient with CKD is very varied, complex, and individual. Dosage must be based on several factors, not only glomerular filtration rates but also other comorbid diseases, interactions with other drugs and clinical condition of the patient.


Drug; dosage; Chronic kidney disease; pharmacokinetic; pharmacodynamic

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Alahdal AM, Elberry AA. Evaluation of applying drug dose adjustment by physicians in patients with renal impairment. Saudi Pharmaceutical Journal. 2012;20(3):217-20.

Matzke GR, Aronoff GR, Atkinson Jr AJ, Bennett WM, Decker BS, Eckardt K-U, et al. Drug dosing consideration in patients with acute and chronic kidney disease—a clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney international. 2011;80(11):1122-37.

Munar MY, Singh H. Drug dosing adjustments in patients with chronic kidney disease. American family physician. 2007;75(10).

Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, et al. Global prevalence of chronic kidney disease–a systematic review and meta-analysis. PloS one. 2016;11(7):e0158765.

Chan SK CL. Drug doses in patients with renal impairment. In: Lai KN, editor. Practical Manual of Renal Medicine Nephrology, Dialysis and Transplantation. Singapore: World Scientific Publishing Co. Pte. Ltd; 2009. p. 443-5.

Doogue MP, Polasek TM. Drug dosing in renal disease. The Clinical Biochemist Reviews. 2011;32(2):69.

Miles C. Assesment of renal function. In: Lerma R, editor. Clinical Decisions in Nephrology, Hipertension and Kidney Transplantation. USA: Springer; 2013. p. 11-5.

Hudson JQ, Nyman HA. Use of estimated glomerular filtration rate for drug dosing in the chronic kidney disease patient. Current opinion in nephrology and hypertension. 2011;20(5):482-91.

Jones GR. Estimating renal function for drug dosing decisions. The Clinical Biochemist Reviews. 2011;32(2):81.

Lam YF, Banerji S, Hatfield C, Talbert RL. Principles of drug administration in renal insufficiency. Clinical pharmacokinetics. 1997;32(1):30-57.

Vassalotti JA, Centor R, Turner BJ, Greer RC, Choi M, Sequist TD, et al. Practical approach to detection and management of chronic kidney disease for the primary care clinician. The American journal of medicine. 2016;129(2):153-62. e7.

Olyaei AJ FT, Lerma EV. Drug dosing in chronic kidney disease. In: N Turner NL, DJ Goldsmith, CG Winearls, J Himmelfarb, G Remuzzi, editor. Oxford Textbook of Clinical Nephrology, 4th Edition. United Kingdom: Oxford University Press; 2016. p. 2911-7.

Quan DJ AF. Dosing of drugs in renal failure. In: B Alldredge RC, M Ernst, B Guglielmo, editor. Applied Therapeutics The Clinical Use of Drugs. USA: Lippincott Williams & Wilkins; 2013. p. 811-4.

Levison ME. Pharmacodynamics of antimicrobial drugs. Infectious Disease Clinics. 2004;18(3):451-65.

Hassan Y, Al-Ramahi RJ, Aziz NA, Ghazali R. Impact of a renal drug dosing service on dose adjustment in hospitalized patients with chronic kidney disease. Annals of Pharmacotherapy. 2009;43(10):1598-605.


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