This page summarises and signposts to medicine related guidance we’re aware of from professional and government bodies relating to coronavirus and renal and urologic disorders.
This page has been put together rapidly in relation to the COVID-19 pandemic.
Whilst we have tried to ensure that the information on this page is complete, please report a concern if you feel anything is omitted or inaccurate.
To see our professional guidance summaries for other clinical areas, click here
Advice in this area includes:
Published November 2020
- This guidance summarises the existing approach to AKI at high level with key points in Covid-19 disease specific management included
- Patients with Covid-19 are at increased risk of AKI. The following drugs are specific additional AKI risks in this patient cohort:
- Diuretic therapy that may have caused hypovolaemia
- Drugs that increase the risks of AKI in the setting of hypovolaemia: NSAIDs, ACE-Inhibitors, angiotensin receptor blockers and SGL2 Inhibitors
- Consider withholding medicines that may worsen renal function in those with AKI: contrast media, NSAIDs, ACE-Inhibitors, angiotensin receptor blockers and diuretics in those who are volume depleted
- Common medicines that may require dose adjustment or cessation in those with worsening renal function: opiates, gabapentin/pregabalin, metformin, antibiotics (e.g. penicillins, vancomycin, teicoplanin), anticoagulants, digoxin, gentamicin and SGLT2/DPP-4
NHS England/NHS Improvement: Clinical guide for renal replacement therapy options in critical care during the coronavirus pandemic
Published November 2020
- The need to provide renal replacement therapy (RRT) to an increasing number of critically ill patients is likely to exceed machine capacity
- In all cases maximal medical management should be considered before attempting RRT including:
- appropriate dose loop diuretics for fluid overload
- potassium binders as per NICE guidance and other measures to manage acute hyperkalaemia – see Clinical guide for acute kidney injury in hospitalised patients with Covid-19 outside the ICU during the coronavirus pandemic
- sodium bicarbonate
- This guideline considers the following RRT options in terms of requirements, modes, access to circulation and anticoagulation:
- continuous veno-venous haemo(dia)filtration (CVVH(D)F)/continuous venovenous haemodialysis (CVVHD)
- slow low efficiency dialysis (SLED),
- intermittent haemodialysis (IHD)/prolonged intermittent dialysis (PIRRT)
- peritoneal dialysis (PD)
Published 6 May 2020
- This guideline aims to help healthcare professionals who are not kidney specialists: prevent, detect and manage acute kidney injury in adults with known or suspected Covid-19
- The recommendations are in order to improve outcomes and reduce the need for renal replacement therapy
- The guideline includes a 1-page visual summary to support decision making
Published 15 May 2020
- This guideline aims to maximise the safety of adults with chronic kidney disease (CKD) during the COVID-19 pandemic. Chapter 3 (page 9) “Managing CKD” includes the advice below on medicines (3.4 to 3.6)
- Advise patients to continue taking their medicines (including ACE inhibitors, angiotensin receptor blockers, immunosuppressants and diuretics) as normal, unless advised to stop by their healthcare professional. This includes patients who have symptoms of COVID-19.
- Be aware that there is no evidence from clinical or epidemiological studies that ACE inhibitors or angiotensin receptor blockers might worsen COVID-19.
- For patients with CKD and suspected or confirmed COVID-19, review the use of medicines, taking into account whether any have the potential to adversely affect renal function.
- Prescribe usual quantities of medicines to meet the patient’s clinical needs. Prescribing larger quantities of medicines puts the supply chain at risk.
Last updated 11 September 2020
- This guideline aims to maximise the safety of patients on dialysis, while protecting staff from infection
- Recommendations support dialysis services to make the best use of NHS resources and match the capacity of dialysis services to patient needs if these become limited because of the COVID-19
- This guideline focuses on what you need to stop or start doing during the pandemic
- This guideline is for health and care practitioners; health and care staff involved in planning/delivering services and commissioners
- Recommendations added on coordinating support for patients with COVID-19 and acute kidney injury; and on emergency pathways for maintaining access sites for patients on dialysis (21 May 2020)
- Guidance clarified for organisations on planned procedures and emergency pathways for creating dialysis access sites for patients with advanced or end-stage kidney disease (11 September 2020)
Kidney Care UK: Coronavirus (COVID-19) guidance for patients with kidney disease
Updated on an ongoing basis
- News and information about COVID-19 for kidney patients
- “Which adults with kidney disease are clinically extremely vulnerable?” includes the following groups on immunosuppressive Therapies:
- Those over 70 and on any form of immunosuppression or have been on one in the past
- Those whose kidney disease is caused by inflammation AND are in one or more of the following patient groups:
- Had within the last 6 months treatment for a flare of kidney disease – with high dose steroids (>20mg per day of prednisolone) and / or cyclophosphamide / rituximab or other biologic drug.
- Taking more than 10mg of prednisolone every day
- For children, the medicine dose that puts them in the extremely vulnerable group may be lower
*Immunosuppressive medications include: azathioprine, leflunomide, methotrexate, MMF, ciclosporin, tacrolimus, sirolimus and belatacept.
Kidney Care UK: Coronavirus guidance for patients with kidney disease: medication
Updated on an ongoing basis
- Patient guidance concerning medication questions including:
- Will taking my immunosuppressive medications put me at higher risk from COVID-19?
- I have high blood pressure, should I stop or change my blood pressure medications?
- Can I take ibuprofen or other NSAIDs?
- Antibiotics or any other new medication you are prescribed (interactions with immunosuppression medicines)
The Renal Association: COVID-19: Information and guidance for health professionals
Updated on an ongoing basis
Provides resources for renal health professionals. Resources of particular relevance to medicines use include:
- COVID-19 vaccination for adult patients with kidney disease: a position statement from the UK renal community [4 December 2020]
- Updated: Guidance on the management of transplant recipients diagnosed with or suspected of having COVID19 includes advice on antiproliferative agents (Aza/MMF), calcineurin inhibitors, high dose steroids, antivirals, chloroquine/hydroxychloroquine and biologics. [Last updated 21 October 2020]
- Guidance for clinicians with patients receiving immunosuppression treatment for autoimmune conditions of their native kidneys which directs which patients receiving immunosuppression should follow prolonged self-isolation. [Last updated 1 April 2020]
- The Renal Association, UK position statement on COVID-19 and ACE Inhibitor/Angiotensin Receptor Blocker use advises patients taking these medications to continue to take them. However, if patients become unwell such that they need to seek medical help, patients are advised that the doctor may recommend stopping the drugs depending on their clinical condition. [Last updated 15 March 2020]
UK Renal Pharmacy Group: Principles of drug dosing during SLED in critically ill patients
Published December 2020
This document outlines the principles of drug dosing during sustained low efficiency dialysis (SLED) and sustained low efficiency diafiltration (SLED-f). The information has been compiled from a range of sources and the clinical experience of the authors, who are involved in the pharmaceutical care of renally-impaired patients. The document includes the following:
- Advantages and disadvantages of SLED versus other forms of dialysis
- Drug clearance during SLED and SLED-f
- Timing of drug administration
- Pharmacokinetics and pharmacodynamics
- Table of individual antimicrobial agents dosing during SLED and SLED-f