Use of Drugs in Uremia and Dialysis
A host of drugs are eliminated by the kidney and thereby require dose adjustment in patients with renal insufficiency (1–5). In addition, some drugs that themselves are not dependent upon the kidney for excretion are converted in the liver to active metabolites that accumulate in patients with diminished renal function (6,7). Examples include Nacetyl procainamide and normeperidine, the metabolites of procainamide and meperidine, respectively. These compounds can accumulate to toxic concentrations in patients with renal insufficiency. To avoid toxicity from either parent drug or active metabolites, doses of many drugs must be adjusted downward in patients with decreased renal function. The precision required in this dose adjustment is not always great and depends upon the therapeutic index of individual drugs. For example, penicillins and cephalosporin antibiotics have wide margins of safety. Many antibiotics in these classes are administered in smaller doses to patients with severe renal insufficiency, but this administration does not require the same degree of precision as dose adjustment with drugs having narrow therapeutic indices, such as aminoglycoside antibiotics. With the latter, serum concentrations are measured to assure attainment of therapeutic yet nontoxic levels (8).
KeywordsRenal Insufficiency Maintenance Dose Normal Renal Function Individual Dose Aminoglycoside Antibiotic
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