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 drugâs 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 ...