Ceftriaxone Use in Stage 3 CKD
For patients with stage 3 chronic kidney disease (CKD), no dosage adjustment of ceftriaxone is required when using standard dosing regimens of 2g or less per day. 1, 2
Pharmacokinetics in CKD
- Ceftriaxone is eliminated via both biliary (40-50%) and renal (30-60%) excretion, making it less dependent on kidney function compared to other antibiotics 1, 3
- In patients with mild to moderate renal impairment (Stage 3 CKD), the elimination half-life is only moderately prolonged (11.9 hours vs 8 hours in normal renal function) 4, 3
- Plasma clearance is reduced by less than 50% in patients with renal impairment compared to those with normal renal function 2
Dosing Recommendations
- For patients with CKD Stage 3 (GFR 30-59 mL/min/1.73m²), standard dosing of ceftriaxone up to 2g daily can be used without adjustment 1, 2
- When using a multiple dosing regimen in CKD patients, a once-daily regimen (e.g., 2g every 24 hours) may be preferable to divided doses (e.g., 1g every 12 hours) to minimize drug accumulation 5, 3
- In patients with both hepatic dysfunction and significant renal disease, caution should be exercised and the ceftriaxone dosage should not exceed 2 grams daily 1
Monitoring Recommendations
- Close clinical monitoring for safety and efficacy is advised in patients with both severe renal and hepatic dysfunction 1
- Monitor for potential neurological adverse reactions, which can occur with ceftriaxone, especially in patients with severe renal impairment 1
- Regular assessment of renal function is recommended during therapy 1
Potential Complications
- Ceftriaxone can form calcium precipitates in the urinary tract, which may lead to urolithiasis and post-renal acute kidney injury 1, 6
- Ensure adequate hydration in patients receiving ceftriaxone to minimize this risk 1
- Discontinue ceftriaxone in patients who develop signs and symptoms suggestive of urolithiasis, oliguria, or renal failure 1
- Monitor prothrombin time in patients with impaired vitamin K synthesis or low vitamin K stores, as ceftriaxone may alter prothrombin times 1
Special Considerations
- Ceftriaxone is not removed by hemodialysis, so supplementary dosing following dialysis is not required 1, 2
- A small percentage of patients with end-stage renal disease may experience substantially prolonged elimination half-life, so monitoring plasma concentrations may be warranted in these cases 2
- In the rare event of overdosage in patients with severe renal impairment, be aware that drug concentration would not be reduced by hemodialysis 1
By following these guidelines, ceftriaxone can be safely and effectively used in patients with stage 3 CKD without significant dose modifications, while maintaining vigilance for potential complications.