Renal Impairment

Question 1

When a question gives you creatinine what are they trying to tell you?

Answer 1

it is an indication to check CrCl or eGFR, they may not directly tell you that their eGFR is severely impaired, and therefore a contraindication for receiving metformin etc. (Manufacturer advises avoid if eGFR is less than 30 mL/minute/1.73 m2)

Question 1

When the BNF says caution with mild renal impairment what do they mean?

Answer 1

Generally
45-60 MILD 3a
30-45 MODERATE 3b
15-30 SEVERE 4
<15 IS RENAL FAILURE 5

Question 2

Which drugs are CONTRA-INDICATED IN RENAL IMPAIRMENT?

Answer 2

Lithium- eGFR < 30
Metformin- eGFR <30
Nitro- eGFR <45, NSAIDS eGFR <30
Opioids- Morphine eGFR <30, Oxycodone eGFR <15, Fentynl should be used in renal failure
Potassium-Sparing Diuretics (e.g., spironolactone, eplerenone)- eGFR < 30
Q
Rivoroxiban and apixiban - eGFR < 15 , dabagitran eGFR <45
SGLT2 Inhibitors (e.g., dapagliflozin, empagliflozin)- eGFR <45 in diabetes, <15 in any condition.
Thiazides- hydrochlorothiazide eGFR <30

Question 3

gent, vanc or teicoplanin dose reduction according to crCl or eGFR?

Answer 3

Use CrCL.

teicoplanin has a much lower threshold for when to reduce maintenance dose compared to the rest. The rest are Crcl 30, teicoplanin is 80.