[Pharmacotherapy in patients with reduced kidney function]

Pharmacotherapy in patients with reduced kidney function Abstract. Pharmacotherapy in patients with chronic kidney disease (CKD) requires careful assessment of renal function and a profound knowledge of dose adaption principles and pharmacological characteristics of the drugs used. Of importance, non-renal clearance is also affected by impaired kidney function. Direct acting anticoagulants play an increasingly important role in daily clinical practice also in patients with impaired kidney function. Limited data suggest possible use even in end stage renal disease. GLP-1-agonists and SGLT-2-inhibitors are new treatment modalities for type 2 diabetes mellitus. The efficacy of glucose lowering by SGLT-2-inhibitors steadily declines with impaired kidney function; however, positive effects on cardiovascular outcomes seem to be preserved in advanced CKD. NSAIDs affect renal hemodynamics as well as tubular function. Severe renal side effects may be observed especially when used in combination with RAAS-inhibitors and diuretics.