MEETINGS & EVENTS

Drug Prescribing in Kidney Disease: Initiative for Improved Dosing (2010)

KDIGO Controversies Conference: Drug Prescribing in Kidney Disease: Initiative for Improved Dosing, Baltimore, USA, May, 2010

(Position Statement Pending)

Background:
Kidney disease, both acute kidney injury (AKI) and chronic kidney disease (CKD), affects every organ system in the body. The physiological changes associated with kidney disease profoundly alter the pharmacology of many drugs. Caregivers must assess kidney function and consider how decreased kidney function changes the disposition of drugs and their active or toxic metabolites. Hypertension, diabetes mellitus, and heart disease frequently compound the management of drugs in patients with kidney disease.

The number of patients with AKI and CKD has increased. Advances in the treatment of acute and chronic disease in general have permitted patients to live longer. Many of them develop decreased kidney function over time. Indeed, kidney function decreases with age, and older patients make up the most rapidly growing patient group for which an understanding of drug disposition is important. When chronic kidney failure occurs, age, diabetes mellitus, and coronary artery disease are no longer barriers to renal replacement strategies.

Novel strategies for treating acute and chronic kidney failure contribute to the need for understanding drug removal during extracorporeal therapies. New dialysis membranes and devices, acceptance of intermittent and continuous peritoneal dialysis, and the application of continuous extracorporeal renal replacement therapies require better understanding of drug transport across biological and artificial membranes.

Proposal:
Kidney Disease Improving Global Outcomes (KDIGO) is convening a Controversies Conference, “Drug Prescribing in Kidney Disease: Initiative for Improved Dosing”. The purpose of this conference is to explore our understanding of drug disposition in patients with AKI and CKD, and to develop rational approaches to pharmacotherapy with practical recommendations for individualized drug dosing. Specifically, the conference will address some key aspects of drug prescribing in CKD. There is a need to develop a consistent framework around which drug dosing recommendations can be established. Authoritative sources vary in their recommendations and discrepancies between their recommendations are evident.

There will be four major areas of discussion: 1) Effects of impaired kidney function on drug disposition, 2) Patient assessment for drug dosing, 3) Calculating drug doses in CKD, 4) Drug removal by renal replacement therapy.

1. Effects of impaired kidney function on:
   a) Absorption and bioavailability
   b) Drug distribution
   c) Drug metabolism and transport
   d) Excretion of drug and metabolites
   
2. Patient assessment for drug dosing
   a) Focusing on specific therapy
   b) Estimating extra-cellular fluid volume
   c) Estimating kidney function
   d) Determining other organ function
   e) Effects of the aging kidney on drug therapy
   
3. Calculating drug doses in CKD
   a) Loading dose
   b) Maintenance doses
   c) Decrease individual doses
   d) Prolong dose interval Dosing
   e) Considerations for specific drug categories in CKD
   f) Dosing considerations for specific drug categories in CKD
   g) Drug level monitoring in CKD
   h) Tools for individualization of drug therapy
   
4. Drug removal by renal replacement therapy
   a) Factors effecting clearance
   b) Drug related
   c) Procedure related
   d) Drug replacement and timing

• Click here to see the published position paper from the conference proceedings (Pending Publication)
• Click here for the complete description and agenda from the conference ( 132KB)
  
• Click here for the roster of conference participants ( 156KB)
  
• Click here for series of conference topic summaries with references ( 720KB)
  

PLENARY SESSION PRESENTATIONS

Effects of impaired kidney function on drug pharmacokinetics and pharmacodynamics ( 314KB) Presenters: William Bennett and Domenic Sica

Patient assessment for drug dosing ( 868KB)
Presenters: Frieder Keller

Calculating drug doses in CKD ( 344KB)
Presenters: Darren Grabe and Lesley Stevens

Calculating drug doses in AKI ( 535KB)
Presenters: Brian Decker and Deborah Pasko

Drug removal by intermittent renal replacement therapies ( 347KB)
Presenter: Arthur Atkinson and Jason Umans

Drug removal by continuous renal replacement therapy and hybrid therapies
( 1.12MB) Presenters: Jan Kielstein and Bruce Mueller

Drug removal by peritoneal dialysis ( 1.23MB)
Presenters: Thomas Golper and Franz Schaefer

Drug dosing in patients with multiple organ dysfunction ( 2.81MB)
Presenters: Gary Matzke and Ravindra Mehta