The patient, the drug and the kidney
Relevant BNF section: Appendix 3
Recent policy changes have focused attention on the prevalence of chronic kidney disease (CKD) in the UK.1–3 In particular, automatic reporting of estimated glomerular filtration rate (e-GFR) is a requirement of the National Service Framework (NSF) for Renal Services in England.1 Also, the Quality and Outcomes Framework (QOF) of the UK General Medical Services (GMS) Contract (revised in April 2006) requires GPs to keep a renal register of patients with CKD with e-GFRs below 60mL/min/1.73m.2,4 Prescribers managing such patients are faced with difficult decisions about starting or continuing treatment with drugs that are handled by, or potentially toxic to, the kidney.4 Here we review methods of identifying and classifying CKD in adults and the implications of CKD for patients' health. We also offer advice on prescribing for these patients while minimising the risks of drug-related renal toxicity. We do not aim to give detailed guidance on every drug, but rather to highlight general principles of drug therapy and key sources of information and advice.
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