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  • Image not available.Chronic kidney disease has been demonstrated to result in minimal alterations in the absorption or bioavailability of only a few drugs.
  • Image not available. The volume of distribution of many drugs is increased in the presence of acute and chronic kidney disease (CKD) as a consequence of volume expansion and reduced protein binding.
  • Image not available. In addition to the expected decrement in renal clearance, nonrenal clearance (i.e., gastrointestinal and hepatic drug metabolism) of several drugs is also reduced in patients with CKD.
  • Image not available. Individualization of a drug dosage regimen for a patient with reduced kidney function is based on the pharmacodynamic/pharmacokinetic characteristics of the drug and the patient's degree of residual renal function.
  • Image not available. The drug dosing guidelines for patients with CKD in many drug information resources are highly variable and thus many are not optimal for clinical use.
  • Image not available. The effect of hemodialysis or peritoneal dialysis on drug elimination is dependent on the characteristics of the drug and the dialysis prescription.
  • Image not available. The application of hemodialysis clearance data to guide drug dosage regimen design for hemodialysis patients is limited and prospective monitoring of serum concentrations is often warranted.

Upon completion of the chapter, the reader will be able to:

  • 1. State the mechanisms by which kidney disease can alter bioavailability of a drug.
  • 2. Describe the effect of chronic kidney disease on protein binding, and list the types of drugs for which binding is typically decreased or increased.
  • 3. Discuss how a change in protein binding can alter the interpretation of serum drug concentrations.
  • 4. Compare the effect of acute kidney injury and chronic kidney disease on drug metabolism.
  • 5. Discuss the mechanism(s) by which chronic kidney disease can affect drug metabolism and list enzymes known to be effected.
  • 6. Calculate the dosage adjustment factor (Q) and use it to modify the dose and/or dosing interval for a drug when given drug- and patient-specific data, including the fraction of the drug eliminated renally unchanged in patients with normal renal function.
  • 7. Develop a loading and maintenance dosage regimen for a patient with chronic kidney disease given patient-specific data and the relationships between the drug’s pharmacokinetic parameters and renal function.
  • 8. Describe the processes by which drugs are removed by hemodialysis.
  • 9. List the factors that influence drug removal by hemodialysis including the relevant drug characteristics and dialysis conditions.
  • 10. Rate the relative efficiency of peritoneal dialysis, conventional hemodialysis and high-flux hemodialysis in removing drugs.
  • 11. Compare and contrast the methods to determine/quantify the effect of hemodialysis on the pharmacokinetics of a drug.

Patients with chronic kidney disease (CKD) are commonly encountered in clinical practice. Indeed, it is estimated that nearly 15 million adults in the United States have serum creatinine values of 1.5 mg/dL (133 mmol/L) or greater.1 In older adults, age-related declines in renal function combine with an increased use of medications to make this patient group particularly susceptible to adverse effects secondary to the ...

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