Article Sidebar

Submitted
Jul 15, 2023
Published
Aug 2, 2025
Download
Pdf
Statistic
Read Counter : 57 Download : 42

Downloads

Download data is not yet available.

Main Article Content

Abstract

Chronic renal disease is a kidney illness marked by a progressive decline in kidney function over months or years. The usage of medications in this condition is a crucial aspect of managing kidney disease patients. When done correctly, pharmacotherapy can halt disease development and minimize morbidity and mortality. In patients with kidney illness, decreasing kidney function can drastically change the pharmacokinetics and pharmacodynamics of many medications, increase the risk of drug toxicity if not well treat. Many of these changes must be expected and mitigated by changing the medicine dosage. Complications of chronic kidney disease (CKD) that go untreated can cause significant early morbidity and mortality, as well as aggravate its progression. This literature review is based on a review of the literature and articles related to CKD to determine the principles of dose adjustment in CKD patients. Classification of drugs in CKD patients includes antifungals, anticoagulants, antidiabetics, antihypertensives, antibiotics, and analgesics. The administration of these drugs should be considered for kidney function in CKD patients. The presence of multidisciplinary interventions reduces the risk of progression of CKD severity. Adjustment of the dosage regimen in CKD patients is carried out for certain drugs that have a significant relationship between drug concentration and clinical outcomes in patients.


 

Keywords

Chronic kidney disease Dosage Pharmacotherapy

Article Details

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

References

  1. Abe, M., Okada, K., & Soma, M. (2011). Antidiabetic Agents in Patients with Chronic Kidney Disease and End-Stage Renal Disease on Dialysis: Metabolism and Clinical Practice. Current Drug Metabolism, 12(1), 57–69. https://doi.org/10.2174/138920011794520053
  2. Aursulesei, V., & Costache, I. I. (2019). Anticoagulation in chronic kidney disease: From guidelines to clinical practice. Clinical Cardiology, 42(8), 774–782. https://doi.org/10.1002/clc.23196
  3. Baker, M., & Perazella, M. A. (2020). NSAIDs in CKD: Are They Safe? American Journal of Kidney Diseases, 76(4), 546–557. https://doi.org/10.1053/j.ajkd.2020.03.023
  4. Bellmann, R., & Smuszkiewicz, P. (2017). Pharmacokinetics of antifungal drugs: Practical implications for optimized treatment of patients. Infection, 45(6), 737–779. https://doi.org/10.1007/s15010-017-1042-z
  5. Betônico, C. C. R., Titan, S. M. O., Correa-Giannella, M. L. C., Nery, M., & Queiroz, M. (2016). Management of diabetes mellitus in individuals with chronic kidney disease: Therapeutic perspectives and glycemic control. Clinics, 71(1), 47–53. https://doi.org/10.6061/clinics/2016(01)08
  6. Bikbov, B., Purcell, C. A., Levey, A. S., Smith, M., Abdoli, A., Abebe, M., Adebayo, O. M., Afarideh, M., Agarwal, S. K., Agudelo-Botero, M., Ahmadian, E., Al-Aly, Z., Alipour, V., Almasi-Hashiani, A., Al-Raddadi, R. M., Alvis-Guzman, N., Amini, S., Andrei, T., Andrei, C. L., Vos, T. (2020). Global, regional, and national burden of chronic kidney disease, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 395(10225), 709–733. https://doi.org/10.1016/S0140-6736(20)30045-3
  7. Coluzzi, F., Caputi, F. F., Billeci, D., Pastore, A. L., Candeletti, S., Rocco, M., & Romualdi, P. (2020). Safe Use of Opioids in Chronic Kidney Disease and Hemodialysis Patients: Tips and Tricks for Non-Pain Specialists.
  8. Therapeutics and Clinical Risk Management, Volume 16, 821–837. https://doi.org/10.2147/TCRM.S262843
  9. Davison, S. N., Rathwell, S., George, C., Hussain, S. T., Grundy, K., & Dennett, L. (2020). Analgesic Use in Patients With Advanced Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Canadian Journal of Kidney Health and Disease, 7, 205435812091032. https://doi.org/10.1177/2054358120910329
  10. Dominijanni, S., Cipriani, S., Malaguti, M., Triolo, L., Ansali, F., & Floccari, F. (2017). Antidiabetic Medication in Patients with Chronic Kidney Disease: What’s New? Nephrology @ Point of Care, 3(1), napoc.5000210. https://doi.org/10.5301/napoc.5000210
  11. Etebu, E., & Arikekpar, I. (2016). Antibiotics: Classification and mechanisms of action with emphasis on molecular perspectives. International Journal of Applied Microbiology and Biotechnology Research, 4, 90–101.
  12. Eyler, R. F., & Shvets, K. (2019). Clinical Pharmacology of Antibiotics. Clinical Journal of the American Society of Nephrology, 14(7), 1080–1090. https://doi.org/10.2215/CJN.08140718
  13. Hoff, B. M., Maker, J. H., Dager, W. E., & Heintz, B. H. (2020). Antibiotic Dosing for Critically Ill Adult Patients Receiving Intermittent Hemodialysis, Prolonged Intermittent Renal Replacement Therapy, and Continuous Renal Replacement Therapy: An Update. Annals of Pharmacotherapy, 54(1), 43–55.
  14. https://doi.org/10.1177/1060028019865873
  15. Hudson, J. Q., & Nolin, T. D. (2018). Pragmatic Use of Kidney Function Estimates for Drug Dosing: The Tide Is Turning. Advances in Chronic Kidney Disease, 25(1), 14–20. https://doi.org/10.1053/j.ackd.2017.10.003
  16. Kakitapalli, Y., Ampolu, J., Madasu, S. D., & Sai Kumar, M. L. S. (2020). Detailed Review of Chronic Kidney Disease. Kidney Diseases, 6(2), 85–91. https://doi.org/10.1159/000504622
  17. Keller, F. (2015). Pharmacokinetic and pharmacodynamic considerations of antimicrobial drug therapy in cancer patients with kidney dysfunction. World Journal of Nephrology, 4(3), 330. https://doi.org/10.5527/wjn.v4.i3.330
  18. Ku, E., Lee, B. J., Wei, J., & Weir, M. R. (2019). Hypertension in CKD: Core Curriculum 2019. American Journal of Kidney Diseases, 74(1), 120–131. https://doi.org/10.1053/j.ajkd.2018.12.044
  19. Kyriakopoulos, C., & Gupta, V. (2025). Renal Failure Drug Dose Adjustments. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK560512/
  20. Lexi-Comp, I., & American Pharmaceutical Association. (2019). Lexicomp Drug information handbook (28th ed.). Wolters Kluwer.
  21. Marriott, J., Cockwell, P., & Stringe, S. (2019). Clinical Pharmacy and Therapeutics. In: Chronic Kidney Disease and End-Stage Renal Disease. Elsevier, 294–316.
  22. Nolin, T. D. (2015). A Synopsis of Clinical Pharmacokinetic Alterations in Advanced CKD. Seminars in Dialysis, 28(4), 325–329. https://doi.org/10.1111/sdi.12374
  23. Pugh, D., Gallacher, P. J., & Dhaun, N. (2019). Management of Hypertension in Chronic Kidney Disease. Drugs, 79(4), 365–379. https://doi.org/10.1007/s40265-019-1064-1
  24. Roberts, D. M., Sevastos, J., Carland, J. E., Stocker, S. L., & Lea-Henry, T. N. (2018). Clinical Pharmacokinetics in Kidney Disease: Application to Rational Design of Dosing Regimens. Clinical Journal of the American Society of Nephrology, 13(8), 1254–1263. https://doi.org/10.2215/CJN.05150418
  25. Schonder, K. (2016). Chronic and End-Stage Renal Disease. In M. Chisholm-Burns, T. L. Schwinghammer, B. G. Wells, P. M. Malone, J. M. Kolesar, & J. T. DiPiro (Eds.), Pharmacotherapy: Principles & Practice Fourth Edition (4th ed., pp. 399–426). McGraw-Hill Education.
  26. Shankar, R., Tyagi, A., Panda, P., Madaan, S., Jeladharan, R., & Kaistha, N. (2021). Deadly dual fungal infections in a chronic kidney disease patient. Journal of Medical Evidence, 2(1), 30. https://doi.org/10.4103/JME.JME_33_20
  27. Sinha, A. D., & Agarwal, R. (2019). Clinical Pharmacology of Antihypertensive Therapy for the Treatment of Hypertension in CKD. Clinical Journal of the American Society of Nephrology, 14(5), 757–764. https://doi.org/10.2215/CJN.04330418
  28. Sowinski, K., Churchwell, M., & Decker, B. (2020). Chronic Kidney Disease. In Pharmacotherapy: A Pathophysiologic Approach (11th ed., pp. 1904–1991). McGraw Hill Medical.
  29. Vondracek, S. F., Teitelbaum, I., & Kiser, T. H. (2021). Principles of Kidney Pharmacotherapy for the Nephrologist: Core Curriculum 2021. American Journal of Kidney Diseases, 78(3), 442–458. https://doi.org/10.1053/j.ajkd.2021.02.342
  30. Weking, K. K., Geografi, L., & Sinaga, C. R. (2024). Study of Medicine Dosage Adjustments in Inpatients with Chronic Kidney Disease. JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice), 14(3), 180. https://doi.org/10.22146/jmpf.88181