Evolution within the field of dialysis and advances in surgical procedures providing for superior access for shunt placement have made it possible to treat patients with end-stage renal disease with dialysis therapy for more than 50 years. Improved pharmacotherapy of pre- and post- dialysis has also contributed to these remarkable advancements. Drug therapy is also evolving. Health care provider for patients with renal diseases needs to understand the latest drug therapy and ensure appropriateness of therapy in each individual patient .
Renal insufficiency and dialysis alter the pharmacokinetics and pharmacodynamics of most commonly used drugs. Of note, an average of eight different classes of drugs per patient are prescribed in patients with renal failure. In comparison to the general population, patients with renal insufficiency experience significantly more adverse drug reactions. Therefore, clinicians caring for these patients must be familiar with the pharmacokinetic behavior of each agent and of the impact of renal failure on the drug elimination process. Understanding the time course of pharmacotherapy is based on knowledge of the relationship between drug concentration and effect. Drugs act by affecting biochemical and physiological processes in the body. Most drugs act at specific receptors but may produce multiple effects because of the location of the receptor in various organs. Knowledge of these properties helps to predict the behavior of a drug in the body and is an important guide in the selection of appropriate doses and dosage intervals.
KeywordsRenal Failure Renal Replacement Therapy Drug Level Therapeutic Drug Monitoring Continuous Renal Replacement Therapy
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