Testing and monitoring
Consider assessing kidney function in patients using a medicine that may impair or adversely affect kidney function.1
Kidney function monitoring is important regardless of how long a medicine has been used.1
Patients with pre-existing kidney disease (older patients are at higher risk) may be particularly susceptible to nephrotoxicity caused by renally excreted medicines.1,2 When these medicines are required in these patients, individualise dose using:2,3
- Therapeutic drug monitoring: e.g. measure blood levels of digoxin
- A valid marker of the medicines effect: e.g. watch for signs of toxicity with digoxin (e.g. anorexia, nausea, confusion)
When to assess
Consider kidney function assessment when:2
- conducting a periodic review to assess possible age-related decline in GFR
- patient experiences dehydration
- prescribing a new renally excreted or nephrotoxic medicine
- patient experiences symptoms suggesting toxicity or an adverse drug reaction
- patient has been hospitalised recently.
- Bell JS, Blacker N, Leblanc VT, et al. Prescribing for older people with chronic renal impairment. Aust Fam Physician 2013;42:24–8. [PubMed]
- Australian medicines handbook 2013. Adelaide: Australian Medicines Handbook Pty Ltd, 2013.
- Kidney Health Australia. Chronic kidney disease (CKD) management in general practice. 2nd edition. 2012. http://www.kidney.org.au//LinkClick.aspx?fileticket=vfDcA4sEUMs%3d&tabid=635&mid=1584 (accessed 30 May 2013).