Dyslipidemia is frequent in patients with renal failure and in transplant recipient patients. & An, M. update on renoprotective and nephrotoxicity of statins. Data acquisition: Mei-Yi Wu, Tzu-Ting Chen, Yun-Chun Wu, Sui-Lung Su, Kuo-Cheng Lu, Jin-Shuen Chen, Fung-Chang Sung, Chien-Te Lee, Yu Yang, Shang-Jyh Hwang, Ming-Cheng Wang, Yung-Ho Hsu, Hung-Yi Chiou. Kakuta S. New York, N.Y.: McGraw-Hill, 2005:185–215.Chobanian AV, A fixed-dose combination with hydrochlorothiazide should not be used in patients with a creatinine clearance less than 30 mL per minute (0.5 mL per second)Maximal dosage in patients with renal impairment is 10 mg dailyThiazides should not be used in patients with a creatinine clearance less than 30 mL per minute; however, thiazides are effective in these patients when used with loop diureticsDosage adjustment (percentage of usual dosage) based on GFR (mL per minute per 1.73 mGFR = glomerular filtration rate; ACE = angiotensin-converting enzymeTable provides general dosing information; dosages may be different for specific indicationsMay need to use lower initial doses in patients receiving diureticsLess likely than other ACE inhibitors to accumulate in patients with renal failure.

Cheung AT. First, this was a retrospective cohort study with a short follow-up period (1–6 years). The K/DOQI chronic kidney disease staging system In patients with chronic kidney disease, over-the-counter and herbal medicine use should be assessed to ensure that medications are indicated; medications with toxic metabolites should be avoided, the least nephrotoxic agents should be used, and alternative medications should be used if potential drug interactions exist.Physicians should be aware of drugs with active metabolites that can exaggerate pharmacologic effects in patients with renal impairment.Dosages of drugs cleared renally should be adjusted based on the patient's renal function (calculated as creatinine clearance or glomerular filtration rate); initial dosages should be determined using published guidelines and adjusted based on patient response; serum drug concentrations should be used to monitor effectiveness and toxicity when appropriate.In patients with chronic kidney disease, over-the-counter and herbal medicine use should be assessed to ensure that medications are indicated; medications with toxic metabolites should be avoided, the least nephrotoxic agents should be used, and alternative medications should be used if potential drug interactions exist.Physicians should be aware of drugs with active metabolites that can exaggerate pharmacologic effects in patients with renal impairment.Dosages of drugs cleared renally should be adjusted based on the patient's renal function (calculated as creatinine clearance or glomerular filtration rate); initial dosages should be determined using published guidelines and adjusted based on patient response; serum drug concentrations should be used to monitor effectiveness and toxicity when appropriate.Inappropriate dosing in patients with chronic kidney disease can cause toxicity or ineffective therapy. Castellsague J, Severe hepatic cirrhosis: Use with extreme caution; maximum dose: Wellbutrin®: 75 … New York, N.Y.: Parke-Davis. Slavin D, The MDRD equation has been shown to be the best method for detecting a GFR lower than 90 mL per minute per 1.73 mAge, sex, race, serum urea nitrogen, serum albumin, serum creatinineNational Kidney Disease Education Program Web site:Age, sex, race, serum urea nitrogen, serum albumin, serum creatinineNational Kidney Disease Education Program Web site:Loading doses usually do not need to be adjusted in patients with chronic kidney disease.

Weir MR. The renoprotective effect of statins had the trend but not statistically significant in all CKD patients after adjustment for demographic and clinical characteristics including age, sex, comorbidities, alcohol use, betel nut use, smoking, BMI, baseline eGFR, baseline UPCR, and statin use within 1 year before the index date (crude OR 0.93, 95% CI 0.78–1.10; aOR 0.80, 95% CI 0.62–1.01). Access This ArticleMYRNA Y. MUNAR, PharmD, BCPS, is an associate professor in the Department of Pharmacy Practice at Oregon State University College of Pharmacy, Portland, and is an adjunct assistant professor in the Department of Physiology and Pharmacology at the Oregon Health and Science University School of Medicine, Portland. Murphy EJ. You can also search for this author in Bennett WM, Davis RB, Physicians should be familiar with commonly used medications that require dosage adjustments. As a result, it is crucial for those patients' physicians to be aware of how to handle these drugs when renal function is impaired and/or when cyclosporine is co-administered.Most statins have an extensive hepatic elimination and the renal route is usually a minor elimination pathway. Use of angiotensin-converting enzyme inhibitors in patients with heart failure and renal insufficiency: how concerned should we be by the rise in serum creatinine?