Drugs in Renal Disease - An Expert?

[Lazy Nite]

Hey ppl

I’ve always found this topic tricky…but really interesting.

A very good source would be the ‘Renal Drug Handbook’, but not everyone keeps this book.

I understand that in renal impairment you have reduced drug clearance and in some cases dose adjustments are needed.

Patients may be on narrow therapeutic range drugs (digoxin, lithium etc), nephrotoxic drugs (frusemide, gentamicin etc) or may be having dialysis.

How are these managed in the community?

Does anyone have anything interesting they’ve come across???

Or any good sources to read???

Any suggestions please???

[Shwampa]

This paper from bmj assessing the quality of the 4 major resources for dosing in renal impairment: Systematic comparison of four sources of drug information regarding adjustment of dose for renal function -- Vidal et al. 331 (7511): 263 -- BMJ

Best online help: Renal Dosing Database - Index (home) Page

[Lazy Nite]

Thank you Shwampa

A very useful link…it’s given me a good insight. I guess for adults there is plenty of information out there, but for children hardly anything.

It must be tricky in community, as you don’t have the relevant tests ‘creatinine and urea’.

….it seems ‘Drugs in renal disease’ is not a hot topic on the forum.

I got one case study here:

Mr GS has ‘moderate renal impairment’. He is fairly active man, non-smoker, and weighs 85 kg.

Vancomycin 2g OD
Frusemide 80mg BD
Tazocin 2g QDS
Ramipril 5mg OD

What changes would people make? What do you think?

[Shwampa]

Moderate impaired renal function is per definition (CrCl = 10 to 20 ml/min).

There're different guidelines about vanco dosing, but for sure you need to reduce the dose. Have a look at http://www.glasgowformulary.scot.nhs...une%202008.pdf

Cocommitant use of fuorsemide and vancomycine increases the risk of ototoxicity: either suspend furosemide, or reduce dose and monitor hearing function.

Tazocin need dosage adjustment in renal impairment.

Ramipril dose is high as well http://www.nps.org.au/__data/assets/...R_ramipril.pdf

[Jeff]

How are these managed in the community?

The ostrich system is used.
No one mentions renal impairment and we don't go looking for it.
Then everyone is happy.

Jeff

[Raju]

It would be good if there was some kind of expert help line that could be used by pharmacists and other healthcare professionals for renal problems. I've had a few situations where I've been desperately scouring the internet for "relative risks" for certain drug regimes with patients with severe renal impairment.

[Jeff]

It would be good if there was some kind of expert help line that could be used by pharmacists and other healthcare professionals for renal problems. I've had a few situations where I've been desperately scouring the internet for "relative risks" for certain drug regimes with patients with severe renal impairment.

Medicines Information Services numbers listed in the BNF

or

http://www.swmit.nhs.uk/Renal.htm


Jeff