Early research on renal function and drug action

Since the 1960s, systematic studies of drug action in renal failure have found many differences between patients with renal failure and those without. Impaired excretion of drugs was known much earlier and was related to glomerular filtration rate. Kunin first tabulated the pharmacokinetics of antimicrobials and dosage recommendations for azotemic patients in 1967. Other effects of renal failure on drug action include increases in some pathways of drug metabolism with decreases in others and no change in the rest. Some changes in specific drug distribution, drug-protein binding, and drug sensitivity have been demonstrated. This knowledge makes the response of an azotemic patient to a specific dose of a specific drug more predictable than before. This predictability makes drug therapy both safer and more effective for azotemic patients.