Drug dosing in patients with renal insufficiency. A simplified approach

Because renal impairment interferes with the disposition of drugs, the dosage of many medications needs adjustment to prevent excess morbidity and prolonged hospital stays. Physiologic considerations in patients with renal insufficiency include serum albumin levels, creatinine clearance, volume status, cardiac function, and body weight. Dosing errors in the hospital can be minimized by using (1) a computerized system of reporting serum creatinine levels and (2) a pharmacokinetic monitoring service to assure optimal benefit from a drug without its toxic effects. Drug interactions are common and may alter the metabolism of other agents; therefore, medication lists should be updated and reviewed regularly.