Improving Drug Use and Dosing in Chronic Kidney Disease

Patients with chronic kidney disease (CKD) are very complex with regard to disease, comorbidity, number of medications, and dosage regimens. In this chapter we discuss (1) the implications of creatinine standardization and use of estimated creatinine clearance or glomerular filtration rate in drug dosing assessment in CKD patients and in special CKD populations (obese and elderly); (2) key principles that all clinicians should be aware of when prescribing medications for patients with CKD; (3) pharmacokinetic and dosing information on selected newer drugs (direct oral anticoagulants, newer diabetes agents); (4) how to assess a new drug for dialyzability and initial dosing in a patient receiving kidney replacement therapy (KRT); and (5) evidence to suggest best practices for team care, transitions of care, and informatics approaches or tools that may improve health outcomes and reduce costs.