Drug dosing in renal dysfunction & replacement therapy

Question 1

What are three ways in which renal disease could affects a drug ?

Answer 1

1. Patient susceptibility
2. PD change
3. PK change

Question 2

Increased drug clearance…

Answer 2

lower drug concentrations

Question 3

decreased drug clearance

Answer 3

higher drug concentrations

Question 4

What is Chronic kidney disease (CKD)?

Answer 4

kidney disease in which there
is a gradual loss of kidney function occurring over a period of months to
years.

Question 5

Kidney

Answer 5

organ primarily tasked with excretion

Question 6

Chronic kidney disease (CKD) subdivides into?

Answer 6

5 stages

Question 7

What is the key clinical measure of kidney function?

Answer 7

GFR

Question 8

How GFR can measure kidney function?

Answer 8

decrease in GFR is associated with a decrease in drug clearance & therefore dosage needs to be reduced

Question 9

Function of estimated GFR (eGFR)?

Answer 9

eGFR is used to classify & monitor CKD severity

Question 10

Definitions of CKD ?

Answer 10

Defined as either kidney damage or a decreased glomerular filtration rate (GFR) of < 60 mL/min/1.73 m2 for at least 3 months.

Question 11

Stage 1

Answer 11

Kidney damage with normal or increased GFR (>90 mL/min/1.73 m 2)

Question 12

Stage 2

Answer 12

Mild reduction in GFR (60-89 mL/min/1.73 m 2)

Question 13

Stage 3a CKD

Answer 13

Moderate reduction in GFR (45-59 mL/min/1.73 m 2)

Question 14

Stage 3b CKD

Answer 14

Moderate reduction in GFR (30-44 mL/min/1.73 m 2)

Question 15

Stage 4 CKD

Answer 15

Severe reduction in GFR (15-29 mL/min/1.73 m 2)

Question 16

Stage 5 CKD

Answer 16

Kidney failure (GFR < 15 mL/min/1.73 m 2 or dialysis)