Kidney medications list
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Comprehensive List of Kidney Medications: An Overview
Nephrotoxic Medications in Acute Kidney Injury (AKI)
Identifying Nephrotoxic Medications
Medications are a significant cause of acute kidney injury (AKI), particularly in hospitalized children. The Nephrotoxic Injury Negated by Just-in-time Action (NINJA) quality improvement collaborative developed a consensus list of nephrotoxic medications (NTMx) to standardize the identification and management of these drugs. This list is reviewed and updated annually to ensure it reflects the latest evidence and clinical practices.
Common Nephrotoxic Drug Classes
Several drug classes are frequently associated with nephrotoxicity, including antimicrobials, antihypertensives, nonsteroidal anti-inflammatory drugs (NSAIDs), immunosuppressive medications, statins, proton pump inhibitors, and certain herbal supplements. Awareness and careful management of these medications can help reduce the risk of kidney damage.
Medications for Chronic Kidney Disease (CKD)
Renally Relevant Drug List (RRD-List)
For patients with chronic kidney disease (CKD), a renally relevant drug list (RRD-list) has been developed to optimize medication use. This list categorizes drugs based on their renal relevance and provides treatment alternatives and advice for healthcare professionals. The RRD-list includes 16 renally relevant drug groups with 36 drug classes, aiming to improve medication safety and efficacy in CKD patients.
Dose Adjustment and Avoidance
A modified Delphi study identified 24 medications commonly used in primary care that require dose adjustment or avoidance in CKD patients. These include baclofen, metformin, digoxin, and newer SGLT2 inhibitors. Proper dose adjustment or avoidance of these medications can significantly reduce the risk of adverse effects in CKD patients.
Pharmacotherapy Principles in Kidney Disease
Core Curriculum for Nephrologists
Pharmacotherapy is crucial in managing kidney disease, but reduced kidney function can alter the pharmacokinetics and pharmacodynamics of many medications. Nephrologists must carefully design medication regimens, particularly for anticoagulants, anti-infectives, analgesics, antidiabetics, and antihypertensives, to prevent drug toxicity and optimize treatment outcomes.
Drug-Induced Renal Failure
Medications can cause renal failure through various mechanisms, including hemodynamic changes, direct renal tubular toxicity, crystal deposition, and osmotic nephrosis. Drugs such as cyclooxygenase-2 inhibitors, antiviral agents (e.g., cidofovir, adefovir, tenofovir), and bisphosphonates (e.g., pamidronate) are known to induce renal failure through these mechanisms.
Medication Discrepancies in Late-Stage CKD
Risk Factors and Common Discrepancies
Late-stage chronic kidney disease (LS-CKD) patients often experience medication discrepancies due to frequent hospitalizations, fragmented care, and polypharmacy. Cardiovascular drugs, vitamins, bone and mineral disease agents, diuretics, analgesics, and diabetes medications are commonly involved in these discrepancies. Factors such as congestive heart failure and the total number of medications increase the risk of discrepancies, highlighting the need for meticulous medication management.
Drug Repurposing in Kidney Disease
Potential Candidates for Repurposing
Drug repurposing involves using existing medications for new clinical indications, offering cost and time advantages. Potential candidates for repurposing in kidney disease include vasodilators (e.g., levosimendan, vitamin D), glucose-lowering drugs (e.g., SGLT2 inhibitors, GLP-1 agonists, metformin), xanthine oxidase inhibitors (e.g., allopurinol, febuxostat), and others. These drugs have shown promise in providing renal and cardiovascular protection beyond their original indications.
Conclusion
Managing medications in kidney disease requires careful consideration of nephrotoxicity, appropriate dosing, and potential drug interactions. Tools like the NTMx and RRD-lists, along with updated pharmacotherapy guidelines, can help healthcare professionals optimize treatment and reduce the risk of adverse effects in patients with kidney disease. Additionally, drug repurposing offers new avenues for effective treatments, potentially improving outcomes for these patients.
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