Drug prescription in chronic kidney disease

Abstract:

Chronic kidney disease (CKD) is often forgotten in everyday practice, although it significantly affects the rate of certain drugs elimination from the body. About 30-50% of side effects are related to CKD grade 3 or higher (GFR<60ml/ min/1,73m2). Most of these side effects are not life-threatening, but can significantly reduce the quality of life. Nonsteroidal antirheumatics, metformin, glimepiride, nitrofurantoin, digoxin, dabigatran, and methotrexate are a few of the very often prescribed drugs contraindicated in G4 and G5 CKD stages, while in the G3 stage the daily dose must be reduced. On the other hand, warfarin, atorvastatin, moxifloxacin, gliclazide, pioglitazone, amiodarone, escitalopram, and benzodiazepines do not require dose reduction in CKD. Since diabetes and arterial hypertension are the main causes of CKD, hypoglycemics, antihypertensives and anticoagulants are the most common dose-adjusted drugs, while nonsteroidal antirheumatic drugs, as the most widely used drugs in general, can directly accelerate the deterioration of nephrons. It is necessary to pay attention to the correct diagnosis and classification of CKD and prescribe drugs in appropriate doses.

Key words:
arterial hypertension; diabetes mellitus; contraindication; chronic kidney disease; chronic therapy