TY - CHAP M1 - Book, Section TI - Drug Therapy Individualization for Patients with Chronic Kidney Disease A1 - Battistella, Marisa A1 - Nolin, Thomas D. A2 - DiPiro, Joseph T. A2 - Yee, Gary C. A2 - Posey, L. Michael A2 - Haines, Stuart T. A2 - Nolin, Thomas D. A2 - Ellingrod, Vicki PY - 2020 T2 - Pharmacotherapy: A Pathophysiologic Approach, 11e AB - KEY CONCEPTSChronic kidney disease (CKD) results in minimal alterations in the absorption or bioavailability of most drugs.The volume of distribution (VD) of many drugs is increased in the presence of acute and CKD as a consequence of volume expansion and/or decreased protein binding.In addition to the expected decrement in renal clearance, nonrenal clearance (ie, gastrointestinal and hepatic drug metabolism and transport) of several drugs is also decreased in CKD patients.Individualization of a drug dosage regimen for a patient with impaired kidney function is based on the pharmacodynamic/pharmacokinetic characteristics of the drug, the patient’s degree of residual renal function, and their overall clinical condition.The drug dosing guidelines for CKD patients in many drug information resources are highly variable and many are not optimal for clinical use.The effect of hemodialysis (HD) or peritoneal dialysis on drug elimination is dependent on the characteristics of the drug and the dialysis prescription.HD clearance data can be used to guide the initial drug dosage regimen recommendation for HD patients; however, prospective monitoring of serum concentrations is often warranted especially for narrow therapeutic index drugs. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesspharmacy.mhmedical.com/content.aspx?aid=1182442766 ER -