Canterbury DHB

Context

Prescribing in Chronic Kidney Disease

fe is the abbreviation for fraction of drug excreted unchanged in the urine.
 
For predominantly renally cleared drugs (fe > 0.5), dose adjustment should be considered in relation to impairment of renal function (creatinine clearance/eGFR).

In This Section

General Advice

Pharmacokinetic Considerations

Pharmacodynamic Considerations

Medicines for which dose adjustment should be considered in chronic kidney disease

General Advice

Pharmacokinetic Considerations

For medicines that are renally cleared i.e. fe > 0.5.

  1. Choose the maintenance dose, i.e. dose and frequency that you would use in this patient if renal function was normal (CrCl 100 mL/min).
  2. Calculate the patient's creatinine clearance (CrCl) using the Cockcroft and Gault calculator.
  3. Calculate maintenance dose:

If further information is required, contact the ward pharmacist or Medicines Information (Phone 80900).

Pharmacodynamic Considerations

Medicines for which dose adjustment should be considered in chronic kidney disease

Note: Maintenance doses should be adjusted to achieve similar concentrations to that which would occur with standard doses in the setting of normal renal function. Adjustment of maintenance doses includes changes to dose, frequency or both (e.g. smaller dose, reduced frequency). The following is not an exhaustive list. These have been selected from a list of commonly prescribed medicines on the basis of having a high fe (fraction excreted unchanged in urine), or a moderate fe and low therapeutic index. Nephrotoxicity is not a factor for inclusion in this list.

Drug (active metabolite)

fe, fraction excreted unchanged in urine

Location of more detailed guidance

aciclovir

0.8

 

allopurinol (oxypurinol)

0 (0.8)

Hospital HealthPathways

amoxicillin

0.9

 

atenolol

0.9

 

baclofen

0.8

 

benzylpenicillin

0.8

 

bezafibrate

0.4

 

bisoprolol

0.5

 

candesartan

0.6

 

captopril

0.5

 

cefaclor

0.7

 

cefalexin

0.9

 

cefazolin

0.9

 

cefepime

0.8

 

cefotaxime

0.7

 

ceftazidime

0.9

 

ceftriaxone

0.5

 

cefuroxime

0.9

 

cetirizine

0.7

 

cilazapril (cilazaprilat)

0 (0.9)

 

ciprofloxacin

0.5

 

clonidine

0.6

 

colchicine

0.3

 

dabigatran

0.8

Hospital HealthPathways

digoxin

0.8

Hospital HealthPathways

doxycycline

0.4

 

enalapril (enalaprilat)

0.2 (0.8)

 

enoxaparin

0.7

Hospital HealthPathways

ethambutol

0.8

 

flecainide

0.3

 

flucloxacillin

0.7

 

fluconazole

0.8

 

gabapentin

0.9

 

ganciclovir

0.9

 

gemfibrozil

0.6

 

gentamicin

0.9

Pink Book

imipenem

0.7

 

lamivudine

0.8

 

levetiracetam

0.7

 

lisinopril

0.9

 

lithium

1

 

meropenem

0.7

 

metformin

0.9

 

methotrexate

0.9-0.5 (saturable)

 

morphine (m-6-glucuronide)

0 (0.9)

Hospital HealthPathways

nadolol

0.8

 

nicotinic acid

0.4

 

pethidine (norpethidine)

0 (0.9)

 

phenoxymethylpenicillin

0.9

 

piperacillin

0.8

 

pravastatin

0.5

 

quinapril (quinaprilat)

0 (0.9)

 

rivaroxaban

0.4

Hospital HealthPathways

sotalol

0.9

 

teicoplanin

0.8

 

tobramycin

0.9

Pink Book

tramadol (O-desmethyltramadol (M1))

0.2 (0.9)

 

tranexamic acid

0.9

 

valganciclovir

0.8

 

vancomycin

0.9

Pink Book

varenicline

0.9

 

Information about this Canterbury DHB document (191845):

Document Owner:

Not assigned (see Who's Who)

Last Updated:

December 2019 (Prescribing in Chronic Kidney Disease)

Next Review Due:

December 2023

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document.

Topic Code: 191845