[Dosage of drugs in patients with kidney diseases]

There are several reasons, why dosing of drugs in renal patients must be of special concern of the treating doctor. These are the followings: 1. The kidneys are the main eliminating organ for many drugs. This is the reason, why the concentration of drugs in renal parenchyma may reach toxic levels and exert irreversible damage on different morphological structures of this organ. 2. Many drugs are a priori nephrotoxic. In the case, such drugs must be used in renal patients, very careful monitoring of renal function is mandatory in order to avoid serious adverse effects. 3. In patients with failing excretory renal function, and especially in patients on haemodialysis or peritoneal dialysis treatment, knowledge of altered pharmacodynamics and pharmacokinetics of drugs caused both by the uraemic state and renal replacement therapy, is indispensable. 4. Dosing of drugs, in patients with impaired excretory renal function is dependent upon their distribution volume, metabolic half-time, extrarenal clearance, renal clearance by the residual renal parenchyma and target therapeutic level. 5. From the above said it follows, that drug dosing in patients, with renal failure must be based on thorough pathophysiological, clinical and pharmacological knowledge.