Dosing Patients with Kidney Disease Presents Unique Challenges

In an interview with Pharmacy Times, Bruce Mueller, PharmD, interim dean and professor of clinical pharmacy at the University of Michigan College of Pharmacy, said pharmacists are essential in providing the correct dosing to patients with kidney disease.

Mueller said 1 in 7 US adults have chronic kidney disease and 1 in 4 hospitalized patients will develop acute kidney injury, therefore determining an individual’s kidney function can be a challenging task. Although there are many equations taught in pharmacy schools, Mueller said they do not typically have pinpoint accuracy and some logic is required. For example, if a patient has zero urine output, Mueller said they have zero renal function regardless of what any equation says.

Hemodialysis also presents issues when it comes to drug dosing, Mueller said. Many of the 700,000 Americans on hemodialysis have practically no renal function until the machine is turned on, at which point it will clear a lot of the drugs out of their system very quickly.

With all of these considerations in mind, Mueller said pharmacists are essential members of the care team when handling patients with kidney disease.

“If you look at the curricula of anybody else who’s on your team, they don’t have the pharmacokinetics, they don’t have the pharmaceutical sciences, they don’t have the therapeutics that the pharmacy students have, and from that point of view pharmacists should be leading this,” Mueller said.