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Medications in CKD

Many medications are renally cleared and require dose alteration in patients with CKD. It is important to estimate renal function with a current measurement of creatinine, and calculation of GFR before starting a new medication in CKD. The GFR should guide dosing of renally-cleared medications (e.g. allopurinol, trimethoprim/sulfamethoxezole, etc). In addition to appropriate dosing of drugs in CKD, some medications warrant the measurement of blood levels with renal impairment (e.g. digoxin, vancomycin). Some medications should be avoided with modest renal impairment (e.g. metformin) and others should be avoided in severe renal impairment (e.g., enoxaparin). Review and consider the safety of all current and newly prescribed medications in patients with CKD.

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Chertow GM, Lee J, Kuperman GJ,et al. Guided medication dosing for inpatients with renal insufficiency. JAMA. 2001 Dec 12;286(22):2839-44.

Thorevska N, Amoateng-Adjepong Y, Sabahi R, et al.Anticoagulation in hospitalized patients with renal insufficiency: a comparison of bleeding rates with unfractionated heparin vs enoxaparin. Chest. 2004 Mar;125(3):856-63.

Shaw JS, Wilmot RL, Kilpatrick ES Establishing pragmatic estimated GFR thresholds to guide metformin prescribing.Diabet Med. 2007 Oct;24(10):1160-3.

Aronoff GR, Berns JS, Brier ME, et al, Drug Prescribing in Renal Failure: Dosing Guidelines for Adults. Fifth Edition

Last Updated - May 08 2017 15:25:51.

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