Abstract

Community and family physicians often encounter patients with chronic kidney disease (CKD). As compared to patients in the general population, CKD patients have altered drug metabolism and increased susceptibility to drug-induced nephrotoxicity. Factors which affect drug metabolism in CKD patients include impaired drug absorption due to significant uremia and use of concomitant medications, aberrant volume of distribution of drugs, reduced drug binding to albumin and decreased renal elimination of therapeutic compounds and its metabolites. Against these backgrounds, the avoidance of potentially nephrotoxic agents, appropriate dosage modification and minimization of drug interactions are essential in preventing adverse drug reactions in CKD patients. Avoidance of potentially nephrotoxic drugs can be achieved via careful review of the clinical indications of nephrotoxic drugs and consideration of non-nephrotoxic alternatives. Dosage modification should be based on the estimated glomerular filtration rate, which can be measured bydifferent established formula in daily clinical practice. The use of these formulas, however, should take into consideration the accuracy of tests, preference of clinicians and patients, severity of renal impairment and clinical context. Minimization of potential drug-drug interaction can help prevent many life-threatening complications, especially in CKD patients who receive cytotoxic or immunosuppressive therapies. Clinicians should also be alert to the teratogenicity of some common drugs used in CKD patients among female subjects of childbearing age. These measures and practices, when properly adhered and exercised, can ensure prescription safety in CKD patients.