Lysaght et al; J Am Soc Nephrol 2002

1990
2000
2010
426,000
1,490,000
2,500,000
Number of subjects in dialysis increases
USRDS, 2004
Etiology / Risk Factors
Vulnerability factor to DIRD
Exacerbate renal diseases
Accumulate, due to failure of
renal excretion / changes in
protein binding
Be ineffective, e.g thiazide in
moderate/severe renal failure,
uricosurics
Drugs classification base renal elimination
(A) Almost exclusively eliminated by the kidney
(B1) Almost entirely metabolised
Drugs Plasma half life (T1/2)
N S-RF
Paracetamol
Clindamcycin
Propranolol
Rifampicin
Lorazepam
Doxycycline
Nortriptyline
warfarin
2 2
2 3
3 3
3 3
15 15
18 18
30 30
40 40
(B2) Drugs produce pharmacologically
active metabolites (water-soluble)
renal elimination

In RF accumulate
e.g. - Acebutolol, hydralazine,
isosorbide dinitrate
- Allopurinol, carbamazepine
- Chordiazepoxide, diazepam,
clobazam, flurazepam
- Metronidazole, 5-FU
(C) Partly metabolized & partly eliminated
by the kidney
Drugs Plasma half life
N S-RF
Lincomycin
Trimethoprim
Amphetamine
Chlorpropamide
Digoxin
Digitoxin
5 12
10 25
12 24
36 280
36 120
150 240
- Doses must be modified in renal function impairment
especially digoxin
Dosing regimens in renal impairment
(general rule)
Group A/B2 :
Initial dose-normal/slightly
Maintenance dose or interval dose
Group B1 :
Initial dose-normal or in advanced-RD,
Hypoproteinemia, drugs with highly protein binding
Group C :
Initial dose-normal
Maintenance dose/interval dose will be modified
Drugs prescribing guidelines in RF