Potential issues in renal impairment
Asking the right questions and gathering information is important because using medicines in people with renal impairment can lead to issues such as toxicity, increased side effects and reduced therapeutic effects.
Even where mild renal impairment is suspected, the renal function should be checked, and medications reviewed.
Advice for undertaking medication reviews
There are different types of kidney disorders such as Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) which all have different considerations when completing a medication review.
Some kidney disorders can result in people requiring Renal Replacement Therapies (RRT).
To help inform your review, follow the advice in our article Assessing the impact of renal impairment on medicines safety.
Take a stepwise approach for gathering information when managing medicines in people with renal impairment.
The following information will help you understand the person’s overall health:
- get the person’s age, gender, height and recent weight, recent creatinine level and date it was measured, to help calculate renal function
- ask about any other medical conditions that may affect the choice of medicine or dose (e.g. heart failure, liver disease, sepsis)
- establish if the person is under the care of a renal (or other) specialist, in case changes to medicines are needed
Find out if the person has an established kidney disease.
See our information on assessing the impact of renal impairment on medicines safety in adults for further information on the different types of kidney disease.
The following information will help you understand the nature and extent of any renal impairment:
- obtain the person’s current calculated renal function and see if this has changed from previous measurements to determine if renal function is stable or changing
- establish the presence and type of any kidney function disorder e.g. Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD)
- identify any medicines suspected of causing the renal impairment (e.g. penicillins, diuretics, aminoglycosides)
- understand the amount of residual renal function as this will need to be protected, e.g. people on peritoneal dialysis
- if the person is on RRT, find out which type and how often
Do not assume that people with kidney transplants have normal renal function. It should also be noted that people with no kidney function are at risk of medicine accumulation rather than renal impairment.
Undertake a full medication history to establish the following:
- current medication and doses (prescription and non-prescription)
- if the person currently taking the medicines as prescribed
- for medicines that are being taken, are they effective and is the person experiencing any side effects
- use of food supplements and/or complementary medicines in case they interact with other medicines or are additive to renal impairment
If you are thinking about recommending an alternative to their current medicine, you may want to consider:
- if any alternatives have already been considered or tried
- the preferred medicine and dose that would be used if the person did not have renal impairment
Once you have collected as much information as you can, look at our article: Information resources for managing medicines in renal impairment.
Use the information about the person, their renal impairment, and their medication to decide if the medicine is appropriate and safe to use, and if any dose changes are required.
Seek further advice from a renal specialist or contact the SPS Medicines Advice Service when:
- no information for the medicine in renal impairment can be found
- the clinical scenario is complex
- you have doubts and require a second opinion
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