Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Assessing the appropriateness of medication management in patients with renal impairment involves several key steps:
- Evaluate kidney function regularly: Use estimated glomerular filtration rate (eGFR) to classify the stage of chronic kidney disease (CKD) and monitor progression, as medication dosing often depends on eGFR levels. A sustained decrease in GFR of 25% or more over 12 months or a decrease of 15 ml/min/1.73 m2 or more should prompt reassessment of medication appropriateness NICE NG203.
- Consider risk factors for CKD progression: These include cardiovascular disease, proteinuria, previous acute kidney injury, hypertension, diabetes, smoking, certain ethnic backgrounds, chronic NSAID use, and urinary obstruction. These factors may influence medication choices and monitoring frequency NICE NG203.
- Adjust medication dosing based on renal function: Many drugs require dose adjustment or avoidance in CKD to prevent toxicity. For example, caution is advised with NSAIDs due to their potential to worsen kidney function NICE NG203.
- Review potential nephrotoxic medications: Avoid or minimize use of drugs that can cause further renal damage or accumulation, and monitor for adverse effects closely.
- Engage in shared decision-making: Involve patients and carers in discussions about medication risks and benefits, considering their preferences and the impact on quality of life NICE NG203,NICE NG107.
- Provide education and support: Offer tailored information about CKD, medication effects, and self-management strategies to empower patients in managing their condition safely NICE NG203.
Overall, medication management appropriateness is assessed by integrating kidney function data, individual risk factors, medication properties, and patient preferences, with ongoing monitoring and education to optimize safety and efficacy.