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Related Concept Videos

Factors Affecting Renal Clearance: Renal Impairment01:17

Factors Affecting Renal Clearance: Renal Impairment

Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
Renal Failure: Dose Adjustments01:11

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In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration01:28

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Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area. This equation is...
Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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Stratifying Risk for Renal Insufficiency Among Lithium-Treated Patients: An Electronic Health Record Study.

Victor M Castro1,2, Ashlee M Roberson1, Thomas H McCoy1

  • 1Center for Experimental Drugs and Diagnostics, Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.

Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology
|August 22, 2015
PubMed
Summary

Lithium is a first-line treatment for bipolar disorder, but can cause kidney problems. This study identified risk factors for renal insufficiency in lithium-treated patients, aiding in prevention strategies.

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Area of Science:

  • Nephrology
  • Psychiatry
  • Pharmacology

Background:

  • Lithium is a crucial treatment for bipolar disorder.
  • Concerns about renal insufficiency risk can limit lithium use.
  • Predictive models are needed to manage lithium-associated nephrotoxicity.

Purpose of the Study:

  • To develop a predictive model for renal insufficiency in lithium-treated patients.
  • To identify patient and pharmacotherapy factors associated with increased renal risk.
  • To inform strategies for preventing lithium-induced kidney damage.

Main Methods:

  • Retrospective analysis of electronic health records (2006-2013).
  • Identified 1445 adult patients with lithium-associated renal insufficiency.
  • Used logistic regression and risk set sampling for model development and validation.

Main Results:

  • Older age, female sex, smoking, hypertension, comorbidities, and schizophrenia/schizoaffective disorder were linked to higher renal risk.
  • The predictive model achieved an ROC AUC > 0.81.
  • Once-daily dosing, lithium levels > 0.6 mEq/L, and first-generation antipsychotics increased risk.

Conclusions:

  • Risk for lithium-induced renal insufficiency can be stratified.
  • Strategies like once-daily dosing and maintaining lower lithium levels may reduce risk.
  • Informed clinical decisions can optimize lithium therapy and patient outcomes.