![]() For example, kidney disease may be chronic (slowly progressive over months or years) or acute (rapidly evolving), and each scenario requires a different approach to drug dosing. Prescribing to patients with kidney disease is complicated, because kidney disease has multiple effects on pharmacokinetics, and these effects are dependent on both the drug and the clinical context. Knowledge of basic pharmacokinetic principles is important for all prescribers, but it is particularly important for nephrologists and other physicians who routinely see patients with organ dysfunction that affects drug handling. We discuss the principles of pharmacokinetics that are fundamental for the design of an appropriate dosing regimen in this review.ĭrugs are an important and frequently used treatment for patients with kidney disease. This offers an opportunity to provide personalized medical care and minimizes adverse drug events from either under- or overdosing. The required change in the dosing regimen can be estimated or even quantitated in certain instances through the application of pharmacokinetic principles to guide rational drug dosing. This, and the use of kidney replacement therapies further complicate attempts to quantify drug clearance at the time of prescribing and dosing in AKI. Although in CKD, these changes progress relatively slowly, they are dynamic in AKI, and recovery is possible depending on the etiology and treatments. Whether kidney disease is acute or chronic, drug clearance decreases, and the volume of distribution may remain the same or increase. Although some guidelines are available for dosing in kidney disease, they may be on the basis of limited data or not widely applicable, and therefore, an understanding of pharmacokinetic principles and how to apply them is important to the practicing clinician. There are multiple physiologic effects of impaired kidney function, and the extent to which they occur in an individual at any given time can be difficult to define. ![]() Prescribing to patients with kidney disease requires knowledge about the drug, the extent of the patient’s altered physiology, and pharmacokinetic principles that influence the design of dosing regimens. ![]() Kidney disease is an increasingly common comorbidity that alters the pharmacokinetics of many drugs. ![]()
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