Drugs in Renal Failure

SWMIT provides information and advice on the adjustment of drug dosage in patients with renal impairment and/or on renal replacement therapies. The centre is staffed by 5 pharmacists and 1 pharmacy technician, who are all experienced in providing medicines information. We are based at the Bristol Royal Infirmary but are separate to the hospital’s own local Medicines Information Centre.

The types of enquiry answered include:

  • Drug dose adjustments in renal impairment and renal failure
  • Drug dose adjustments for patients on renal replacement therapies

Information on adverse effects of drugs on the kidney and drugs in renal transplantation is NOT included in our databases.

There is no adult renal unit attached to the Bristol Royal Infirmary, and therefore it is advised that enquirers seeking practical advice do so from their local renal units. Our nearest adult renal unit is at Southmead Hospital in Bristol, and support us when clinical opinion is required.

Renal Enquiries

Prior to contacting the centre, we would expect a standard search to have been carried out, as answers can sometimes be found in resources held at Medicine Information centres.

The list below is provided as a template for a background search before contacting SWMI. We appreciate that some MI centres will not hold all of these resources.

Information required

When contacting the centre with an enquiry, the following background information will be required to enable a full answer to be given:

  • If the enquiry is patient specific
  • Age and weight of patient
  • Degree of renal impairment – CrCl or eGFR or recent serum creatinine levels
  • Which, if any, renal replacement therapy is being used
  • If the patient is currently taking the drug in question, if so, at what dose
  • Any other medications
  • Any other medical problems
  • How soon an answer is required

Background Search

For enquiries relating to drug dosing in renal impairment/failure:

It may also be appropriate to contact the manufacturer

For enquiries relating to drug dosing in renal replacement therapies, in addition to the sources listed above:

  • Dialysis of Drugs 2018 George R. Bailie, Nancy A. Mason
  • If no information available, basic drug pharmacokinetic data – such as molecular weight, volume of distribution, protein binding etc will help us estimate the likelihood of drug removal by renal replacement therapies.

Renal Q & As

Available from NHS Evidence

Users of the Renal Q&As which have been previously printed from the internet should ensure that the most up to date version is being employed.
Disclaimer - Please Read

Q&As

Available from www.sps.nhs.uk

  • Which estimate of renal function should be used when dosing patients wuth renal impairment?
  • Should prophylactic doses of low molecular weight heparins be used in patients with renal impairment?
  • Are low molecular weight heparins preferred to unfractionated heparin in people with renal impairment being treated for venous thromboembolism and myocardial infarction?
  • What factors need to be considered when dosing patients with renal impairment?
  • What factors need to be considered when dosing patients on renal replacement therapies?
  • Can oral bisphosphonates be given to patients with renal impairment for the management of osteoporosis?
  • What is the available evidence for the use of statins in patients with renal impairment?
  • Can patients with renal impairment take glucosamine?
  • What is the first choice antidepressant for patients with renal impairment?
  • Which opioids can be used in renal impairment?

  • These documents contains an answer to a specific question about medicines use which has been prepared by UK Medicines Information (UKMi) pharmacists for the NHS.
  • Members of the public, or professionals from outside the UK, may need assistance to interpret these data and to translate it to their own situation. It is strongly recommended that in such cases relevant professional help is sought.
  • The question and answer (Q&A) relates solely to the clinical scenario described within the text, and should you have any doubts about whether this is relevant to a specific patient, or be unsure whether you understand the answer, it is again recommended that professional assistance be requested.
  • Q&As are believed to be an accurate reflection of the medical literature at the time of preparation. However, users should always consult the literature and take account of new developments because these may change an answer.
  • Each Q&A will be deleted 3 years after preparation, unless it has been updated.
  • Where authors have given their contact details at the bottom of the Q&A, this indicates that he or she may be willing to assist with any further enquiries related to the subject. However, enquirers should bear in mind that authors are National Health Service employees concerned with the care of patients in their employing organisation and may not be able to respond quickly. Entering the Q&A indicates that you have read, understood and accepted the above.
  • The authors of Q&As are not responsible for the content of external websites and links are made available solely to indicate their potential usefulness to users of Medicines Resources. You must use your judgment to determine the accuracy and relevance of the information they contain.
  • Q&A documents are intended for use by NHS healthcare professionals and cannot be used for commercial or marketing purposes.
  • Using these Q&As indicates that you have read, understood and accepted the above.