Prolog Administration in Chronic Kidney Disease (CKD)
Prolog can be administered to patients with CKD, but requires careful consideration of kidney function for appropriate dosing and monitoring to prevent adverse effects. 1
General Medication Principles in CKD
- People with CKD are more susceptible to nephrotoxic effects of medications, requiring careful assessment of benefits versus potential harms before prescribing any medication 1
- Monitor eGFR, electrolytes, and therapeutic medication levels in CKD patients receiving medications with narrow therapeutic windows or potential adverse effects 1
- Consider GFR when dosing medications that are cleared by the kidneys to prevent toxicity or reduced efficacy 1
- For most clinical settings, validated eGFR equations using serum creatinine are appropriate for drug dosing decisions 1
Medication Management Approach
- Perform thorough medication review periodically and at transitions of care to assess adherence, continued indications, and potential drug interactions 1, 2
- In patients with extremes of body weight, consider using eGFR non-indexed for body surface area, especially for medications with narrow therapeutic ranges 1
- Where more accuracy is required for drug-related decision-making (e.g., medications with narrow therapeutic ranges), consider using equations that combine both creatinine and cystatin C, or measured GFR 1
- Review and limit the use of over-the-counter medicines and dietary/herbal remedies that may be harmful for people with CKD 1, 3
Special Considerations
- If medications are discontinued during acute illness, communicate a clear plan for when to restart them to the patient and healthcare providers 1
- Consider planned discontinuation of certain medications 48-72 hours prior to elective surgery or during acute adverse events as a precautionary measure 1
- Adapt drug dosing in patients where GFR, filtration markers, or volume of distribution are not in a steady state 1
- When prescribing medications to CKD patients of childbearing potential, review teratogenicity potential and provide reproductive counseling 1
Common Pitfalls to Avoid
- Failing to adjust medication dosages according to kidney function can lead to drug accumulation and adverse events 4, 5
- Overlooking potential drug-drug interactions, which are more common in CKD patients due to polypharmacy 2, 6
- Not accounting for altered pharmacokinetics in CKD patients, which can affect drug absorption, distribution, metabolism, and excretion 4, 5
- Neglecting to reassess medication needs and dosing as kidney function changes over time 7, 6
Monitoring Recommendations
- Regularly assess kidney function using validated eGFR equations to guide ongoing medication dosing decisions 1, 6
- Monitor for signs of medication toxicity or reduced efficacy, particularly with medications that have narrow therapeutic windows 1, 2
- Consider more frequent monitoring in patients with rapidly changing kidney function or those at high risk for adverse drug events 7, 5