Skip to main content
SpringerLink
Log in

Drug Prescribing in Renal Failure

  • Review Article
  • Published:
Drugs Aims and scope Submit manuscript

Summary

Drug prescribing for patients with renal failure should incorporate adjustment of dosage regimens in order to avoid accumulation and thus adverse effects. Drugs usually eliminated by the kidneys require the most modification. Since immediate therapeutic efficacy is of importance, the initial or loading dose is essentially unaltered for patients with renal dysfunction. Maintenance doses can be adjusted by either lengthening the interval between doses or by reducing the size of individual doses. In clinical practice, a combination of both methods is used. Serum levels should be used as guides whenever possible. In interpreting these levels, recognition of decreased plasma protein binding and prolonged elimination half-lives in renal failure is imperative.

In patients requiring dialysis, consideration must be given to adjustments for drug removal by the artificial membrane. Small molecules unbound to proteins are most easily removed.

Specific guidelines for therapy with common drugs prescribed for patients with renal failure are given. These include: (1) narcotics and analgesics; (2) psychotherapeutic drugs; (3) cardiovascular drugs; and (4) antimicrobial agents.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Anderson, R.J.; Gambertoglio, J.G. and Schrier R.W.: in Clinical Use of Drugs in Renal Failure (C.C. Thomas, Springfield 1976).

    Google Scholar 

  • Babb, A.L.; Popovich, R.P.; Christopher, T.G. and Scribner, B.H.: The genesis of the square meter-hour hypothesis. Transactions of the American Society of Artificial Internal Organs 17: 81–91 (1971).

    CAS  Google Scholar 

  • Barza, M.; Brown, R.B.; Shen, B.; Gibaldi, M. and Weinstein, L.: Predictability of blood levels of gentamicin in man. Journal of Infectious Diseases 132: 165–174 (1975).

    Article  PubMed  CAS  Google Scholar 

  • Bennett, W.M.; Bagby, S.P.; Golper, T.A. and Porter, G.A.: Vancomycin therapy for difficult infections in hemodialysis patients. Dialysis and Transplantation 6: 22–23 (1977a).

    Google Scholar 

  • Bennett, W.M.; McDonald, W.M.; Kuehnel, E.; Hartnett, M. and Porter, G.A.: Do diuretics have an antihypertensive effect independent of natriuresis? Clinical Pharmacology and Therapeutics 22: 499–504 (1977b).

    PubMed  CAS  Google Scholar 

  • Bennett, W.M. and Porter, G.A.: Endogenous creatinine clearance as a clinical measure of glomerular filtration rate. British Medical Journal 4: 83–86 (1971).

    Article  Google Scholar 

  • Bennett, W.M.; Singer, I.; Golper, T.; Feig, P. and Coggins, C.J.: Guidelines of drug therapy in renal failure. Annals of Internal Medicine 86: 754–783 (1977c).

    PubMed  CAS  Google Scholar 

  • Bianchetti, G.; Graziani, G.; Biancaccio, D.; Morganti, A.; Leonetti, G.; Manfrin, M.; Sega, R.; Gomeni, R.; Ponticelli, C. and Morselli, P.L.: Pharmacokinetics and effects of propranolol in terminal uremic patients and in patients undergoing regular dialysis treatment. Clinical Pharmacokinetics 1: 373–384 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Brown, ST.; Ahearn, D.G. and Nolph, K.D.: Reduced peritoneal clearances in scleroderma increased by introperitoneal isoproterenol. Annals of Internal Medicine 78: 891–893 (1973).

    PubMed  CAS  Google Scholar 

  • Cockcroft, D.W. and Gault, M.H.: Prediction of creatinine clearance from serum creatinine. Nephron 16: 31–41 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Dettli, L.: Drug dosage in renal disease. Clinical Pharmacokinetics 1: 126–134 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Fabre, J. and Balant, L.: Renal failure, drug pharmacokinetics and drug action. Clinical Pharmacokinetics 1: 99–120 (1976).

    Article  PubMed  CAS  Google Scholar 

  • George, C.R.P.; Guiness, M.D.G.; Lark, D.J. and Evans, R.A.: Minocycline toxicity in renal failure. Medical Journal of Australia 1: 640–641 (1973).

    PubMed  CAS  Google Scholar 

  • Gibson, T.P. and Nelson, H.A.: Drug kinetics and artificial kidneys. Clinical Pharmacokinetics 2: 403–406 (1977).

    Article  PubMed  CAS  Google Scholar 

  • Goodwin, N.J. and Friedman, E.A.: The effects of renal impairment, peritoneal dialysis and hemodialysis on serum sodium colistimethate levels. Annals of Internal Medicine 68: 984–994 (1968).

    PubMed  CAS  Google Scholar 

  • Inturrisi, C.E.: Disposition of narcotics in patients with renal disease. American Journal of Medicine 62: 528–529 (1977).

    Article  PubMed  CAS  Google Scholar 

  • Jelliffe, R.W.: An improved method of digoxin therapy. Annals of Internal Medicine 69: 703–717 (1968).

    PubMed  CAS  Google Scholar 

  • Jelliffe, R.W.; Buell, J.; Kalaba, R.; Sridhar, R.; Rockwell, R. and Wagner, J.G.: An improved method of digitoxin therapy. Annals of Internal Medicine 72: 453–464 (1970).

    PubMed  CAS  Google Scholar 

  • Johnsson, G. and Regardh, C.G.: Clinical pharmacokinetics of beta-adrenoreceptor blocking drugs. Clinical Pharmacokinetics 1: 233–263 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Koch-Weser, J.: Drug therapy: Serum drug concentrations as therapeutic guides. New England Journal of Medicine 287: 227–231 (1972).

    Article  PubMed  CAS  Google Scholar 

  • Kunin, C.M.; Rees, S.B.; Merrill, J.P. and Finland, M.: Persistence of antibiotics in blood of patients with acute renal failure. I. Tetracycline and Chlortetracycline. Journal of Clinical Investigation 38: 1487–1497 (1959).

    Article  PubMed  CAS  Google Scholar 

  • Lipner, H.I.; Ruzany, F.; Dasgupta, M.; Lief, P.D. and Bank, N.: The behaviour of carbenicillin as a non-reabsorbable anion. Journal of Laboratory and Clinical Medicine 86: 183–194 (1975).

    PubMed  CAS  Google Scholar 

  • Lowenthal, D.T.; Briggs, W.A.; Gibson, T.P.; Nelson, H.S. and Cirksena, W.J.: Pharmacokinetics of oral propranolol in chronic renal disease. Clinical Pharmacology and Therapeutics 16: 761–769 (1974a).

    PubMed  CAS  Google Scholar 

  • Lowenthal, D.T.; Briggs, W.A. and Levy G.: Kinetics of salicylate elimination by anephric patient. Journal of Clinical Investigation 54: 1221–1226 (1974b).

    Article  PubMed  CAS  Google Scholar 

  • Maher, J.F.: Principles of dialysis and dialysis of drugs. American Journal of Medicine 62: 475–481 (1977).

    Article  PubMed  CAS  Google Scholar 

  • Morris, A.J. and Bilinsky, R.T.: Prevention of staphylococcal shunt infections by continuous vancomycin prophylaxis. American Journal of Medical Sciences 262: 87–92 (1971).

    Article  CAS  Google Scholar 

  • Nolph, K.D.; Stoltz, M. and Maher, J.F.: Altered peritoneal permeability in patients with systemic vasculitis. Annals of Internal Medicine 75: 753–756 (1971).

    PubMed  CAS  Google Scholar 

  • Odar-Cederlof, I. and Borga, O.: Kinetics of diphenylhydantoin in uremic patients: Consequences of decreased plasma protein binding. European Journal of Clinical Pharmacology 7: 31–37 (1974).

    Article  PubMed  CAS  Google Scholar 

  • Olsen, G.D.; Bennett, W.M. and Porter, G.A.: Morphine and Phenytoin binding to plasma proteins in renal and hepatic failure. Clinical Pharmacology and Therapeutics 17: 677–684 (1975).

    PubMed  CAS  Google Scholar 

  • O’Malley, K.; Velaseo, M; Pruitt, A. and McNay, J.L.: Decreased plasma protein binding of diazoxide in uremia. Clinical Pharmacology and Therapeutics 18: 53–58 (1975).

    PubMed  Google Scholar 

  • Parker, R.; Bennett, W.M. and Porter, G.A.: Estimation of creatinine clearance without urine collection (Unpublished data, 1977).

  • Plamp, C.; Bennett, W.M.; Gilbert, D. and Porter, G.A.: The effect of dosage regimen on experimental gentamicin nephrotoxicity: Dissociation of peak serum levels from renal failure. Clinical Research 26: 141A (1978).

    Google Scholar 

  • Reidenberg, M.M.: The binding of drugs to plasma proteins from patients with poor renal function. Clinical Pharmacokinetics 1: 121–125 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Reidenberg, M.M.; Odar-Cederlof, I.; von Vahr, C.; Borga, O. and Sjoqvist, F.: Protein binding of diphenylhydantoin and desmethylimipramine in plasma from patients with poor renal function. New England Journal of Medicine 285: 264–267 (1971).

    Article  PubMed  CAS  Google Scholar 

  • Shoeman, D.W. and Azarnoff, D.L.: The alteration of plasma proteins in uremia as reflected in their ability to bind digitoxin and diphenylhydantoin. Pharmacology 7: 169–177 (1972).

    Article  PubMed  CAS  Google Scholar 

  • Storstein, L.: Protein binding of cardiac glycosides in disease states. Clinical Pharmacokinetics 2: 220–223 (1977).

    Article  PubMed  CAS  Google Scholar 

  • Suhrland, L.G. and Weisberger, A.S.: Chloramphenicol toxicity in liver and renal disease. Archives of Internal Medicine 112: 161–164 (1963).

    Article  Google Scholar 

  • Szeto, H.H.; Inturrisi, C.E.; Houde, R.W.; Sall, S.; Cheigh, J. and Reidenberg, M.M.: The accumulation of normeperidine, an active metabolite of meperidine, in patients with renal failure or cancer. Annals of Internal Medicine 86: 738–741 (1977).

    PubMed  CAS  Google Scholar 

  • Thompson, W.L.; Reiner, N.E. and Bloxham, D.D.: Gentamicin and tobramycin nephrotoxicity in dogs on continuous or once daily intravenous injection. International Congress of Chemotherapy 208, 1977 (Abstract X).

  • Toole, J.F. and Parrish, M.L.: Nitrofurantoin polyneuropathy. Neurology 23: 554–559 (1973).

    Article  PubMed  CAS  Google Scholar 

  • Viederman, M. and Rusk, G.H.: Psychotherapeutic agents in renal failure. American Journal of Medicine 62: 529–532 (1977).

    Article  PubMed  CAS  Google Scholar 

  • Wagner, J.G.: Loading and maintenance doses of digoxin in patients with normal renal function and those with severely impaired renal function. Journal of Clinical Pharmacology 14: 329–338 (1974).

    PubMed  CAS  Google Scholar 

  • Welling, P.G.; Shaw, W.R.; Uman, S.J.; Tse, F.L.S. and Craig, W.A.: Pharmacokinetics of minocycline in renal failure. Antimicrobial Agents and Chemotherapy 8: 532–537 (1975).

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Nephrology, University of Oregon Health Sciences Center and Veterans Administration Hospital, Portland, Oregon, 97201, USA

    William M. Bennett

Authors
  1. William M. Bennett
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bennett, W.M. Drug Prescribing in Renal Failure. Drugs 17, 111–123 (1979). https://doi.org/10.2165/00003495-197917020-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-197917020-00002

Keywords

Search

Navigation