Dose Adjustment Considerations in Patients With Chronic Kidney Disease: Dr Linda Awdishu

Patients with chronic kidney disease may be on multiple medications that need to be adjusted, which requires coordination with other specialists who may have prescribed those drugs, explained Linda Awdishu, PharmD, FASN, professor and division head of clinical pharmacy at the University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences.

Transcript

How do you balance drug benefits with kidney disease risks, and how often might dose adjustments have to take place?

So, I currently practice in the University of California, San Diego, Chronic Kidney Disease Clinic, and I see patients who have chronic kidney disease, and the kidney disease ranges from stage II to V. And so, for every single patient that comes to clinic, we evaluate their medications. We look at whether there’s a need for a dose adjustment and assess the presence of adverse events from that medication. And so then, that all that information comes into play into a risk assessment.

Where it becomes challenging is you may have certain drugs that are prescribed by other specialties, and they may require a dose adjustment, but as the nephrologist, we shouldn’t be just adjusting the dose without discussion with those specialties. An example would be if a patient is prescribed an antidepressant, and there’s a recommendation to reduce the dose by 25% or 50%, even. Many of these recommendations in the drug compendia are a little vague, right? And it may be difficult to assess the adverse events like patients may say, “I feel perfectly fine, I have no side effects.” So, do we want to risk kind of losing the efficacy of that antidepressant when the patient’s tolerating the medication?

And so that’s kind of the risk assessment we make, and then we always work with the specialty providers to make recommendations and get their input on whether they feel comfortable reducing the dose in that specific individual.