Drug dosing consideration in patients with acute and chronic kidney disease-a clinical update from Kidney Disease: Improving Global Outcomes (KDIGO)
Open accessAbstract
Drug dosage adjustment for patients with acute or chronic kidney disease is an accepted standard of practice. The challenge is how to accurately estimate a patient's kidney function in both acute and chronic kidney disease and determine the influence of renal replacement therapies on drug disposition. Kidney Disease: Improving Global Outcomes (KDIGO) held a conference to investigate these issues and propose recommendations for practitioners, researchers, and those involved in the drug development and regulatory arenas. The conference attendees discussed the major challenges facing drug dosage adjustment for patients with kidney disease. In particular, although glomerular filtration rate is the metric used to guide dose adjustment, kidney disease does affect nonrenal clearances, and this is not adequately considered in most pharmacokinetic studies. There are also inadequate studies in patients receiving all forms of renal replacement therapy and in the pediatric population. The conference generated 37 recommendations for clinical practice, 32 recommendations for future research directions, and 24 recommendations for regulatory agencies (US Food and Drug Administration and European Medicines Agency) to enhance the quality of pharmacokinetic and pharmacodynamic information available to clinicians. The KDIGO Conference highlighted the gaps and focused on crafting paths to the future that will stimulate research and improve the global outcomes of patients with acute and chronic kidney disease.
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Quantification of eGFR levels is essential for modifications of medication dosages or restrictions of use.
“Quantification of eGFR levels is essential for modifications of medication dosages or restrictions of use (Fig. 11.1) (23,24)”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [23]
The Recommendations section says GFR should be used to evaluate kidney function for drug dosing, and Table 3 directs clinicians to assess eGFR or creatinine clearance when individualizing dosage regimens. These passages support using kidney-function estimates to modify doses, but they do not establish that eGFR levels determine restrictions on whether a medication may be used. The paper also recommends the most accurate assessment method for the individual patient, which may be estimated or measured GFR. (LLM, conf=0.83)
Experimental — accuracy not yet measured
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Percentages, sums and reported differences re-computed from the paper’s own numbers.
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- Authors
- Matzke, G. R., Aronoff, G. R., Atkinson, A. J., Bennett, W. M., Decker, B. S., Eckardt, K.-U., Golper, T., Grabe, D. W., Kasiske, B., Keller, F., Kielstein, J. T., Mehta, R., Mueller, B. A., Pasko, D. A., Schaefer, F., Sica, D. A., Inker, L. A., Umans, J. G., & Murray, P.
- Affiliations
- Virginia Commonwealth University (US)
- University of Louisville (US)
- Northwestern University (US)
- Indiana University School of Medicine (US)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- Vanderbilt University Medical Center (US)
- Albany College of Pharmacy and Health Sciences (US)
- Hennepin County Medical Center (US)
- Universität Ulm (DE)
- Medizinische Hochschule Hannover (DE)
- University of California San Diego (US)
- University of Michigan (US)
- Michigan Medicine (US)
- University Hospital Heidelberg (DE)
- Tufts Medical Center (US)
- Georgetown University Medical Center (US)
- University College Dublin (IE)
- Corresponding author
- Matzke, Gary R.
- ORCID
- Venue
- Kidney International
- Publisher
- Elsevier BV
- Published
- 2011-12
- Volume
- 80
- Issue
- 11
- Pages
- 1122-1137
- ISSN
- 0085-2538 (ISSN-L)
- OpenAlex
- W2065570335
- Semantic Scholar
- 2a43c4e7637e1629bf38dc150c6ea56d790de5f7
- Cited by
- 462
- References
- 155
- Citations by year
- 2026: 22 · 2025: 27 · 2024: 29 · 2023: 39 · 2022: 33 · 2021: 34 · 2020: 42 · 2019: 32 · 2018: 32 · 2017: 21 · 2016: 26 · 2015: 35 · 2014: 40 · 2013: 30 · 2012: 18
- FWCI
- 20.85
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Kidney International (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK084260)
- Topics
- Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
- Keywords
- drug dosing, acute kidney injury, chronic kidney disease, renal dose adjustment, glomerular filtration rate, kidney function estimation, renal replacement therapy, drug disposition, nonrenal clearance, pediatric patients, pharmacokinetics, pharmacodynamics, drug regulation
- MeSH terms
- Dose-Response Relationship, Drug, Government Agencies, Humans, Kidney Diseases, Pharmacokinetics, Practice Guidelines as Topic, Renal Replacement Therapy
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