Nephrology Disorders, Introduction
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition
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CAUTION
Check all medicines for possible dose adjustment based on eGFR
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Principles of dosing medication in patients with Chronic Kidney Disease (CKD) and Acute Kidney Injury (AKI)
In the setting of kidney failure, all prescribed medications should be reviewed regularly to ensure that they are safe and at the correct dose for the estimated glomerular filtration rate (eGFR). Currently, the most reliable measure of eGFR is the CKD-EPI in adults and Schwartz equation for children. Nephrotoxic drugs should be avoided in the setting of any kidney dysfunction. Prior to starting any medication, review for previous drug allergies and adverse events. Monitoring of drug toxicity and levels is important where available (e.g. aminoglycosides).
LoE:IVbi
In AKI, the eGFR is not reliable as kidney function changes rapidly. Therefore, it is essential to monitor eGFR and doses of medications regularly. Recommendations for medicines that require dose adjustment in renal impairment can be found in the South African Medicine Formulary (SAMF), package insert, and from many online resources e.g.: http://www.globalrph.com/index_renal/
Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.0_17 October 2024
Chapter 7 Nephrology/Urological Disorders_7.1 Nephrology Disorders