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Specialist Services | Drugs in renal failure

Drugs in renal failure

Drugs in renal failure specialist advisory service

 

 

Introduction

The South West Medicines Information (SWMI) Centre provides information and advice on the adjustment of drug dosage in patients with renal impairment and/or on renal replacement therapies. The centre is staffed by 8 (5 WTE) medicine information pharmacists and 1 specialist medicines information pharmacy technician. We are based at the Bristol Royal Infirmary but are separate to the hospital’s own local Medicines Information Centre.

The types of enquiry answered include:

  • Drug dose adjustments in renal impairment and renal failure
  • Drug dose adjustments for patients on renal replacement therapies

Information on adverse effects of drugs on the kidney and drugs in renal transplantation is NOT included in our databases.

There is no renal unit attached to the Bristol Royal Infirmary, and therefore it is advised that enquirers seeking practical advice do so from their local renal units. Our nearest renal units at Southmead Hospital in Bristol, and The Royal Devon and Exeter Hospital support us when clinical opinion is required.

Who can use the service?

The service is provided to all health care professionals within the NHS but is primarily used by medicines information pharmacists after they have researched their standard resources.

How to make enquiries

The drugs in renal failure specialist advisory service is available between 8.45am and 5.00pm Monday to Friday, excluding Bank Holidays. To contact the centre please call 0117 3422867. There is an answer-phone on which you may leave a message outside of these office hours.

Information required when making an enquiry

When contacting the centre with a patient specific enquiry, the following background information will be required to enable a full answer to be given:

  • Age and weight of patient
  • Degree of renal impairment – CrCl or recent serum creatinine levels
  • Which, if any, renal replacement therapy is being used
  • Is the patient currently taking the drug in question, and if so, at what dose?
  • Any other medications - if relevant
  • Any other medical problems - if relevant
  • How soon an answer is required

Medicines information pharmacists should have looked in standard medicines information reference resources before calling the service. E.g. Manufacturer’s information (Summary of Product Characteristics), BNF, Renal Drug Database or Renal Drug Handbook, Micromedex etc.

Sources of Information

The centre has access to a wide range of standard medicines information textbooks, journals and databases including specialist databases and the Renal Drug Database. We also hold specialist renal textbooks, an in-house database of clinical papers and past enquiries.

Renal databases/ textbooks:  Current editions of the following - 

  • Renal Drug Database, Ashley, C. & Dunleavy, A
  • Drug Prescribing in Renal Failure, Aronoff, G. & Bennett, W. et al
  • Drug Dosing in Renal Insufficiency, Seyffart, G.
  • Handbook of Liver and Kidney Disease, Schrier & Gambertoglio
  • Oxford Handbook of Dialysis, Levy, J et al

Renal Journals:

·         British Renal Journal of Medicine

Guidance

The centre has prepared the following Q&A guidance documents:


Link  What factors need to be considered when dosing patients with renal impairment? 
Link  What factors need to be considered when dosing patients on renal replacement therapies? 
Link  Can oral bisphosphonates be given to patients with renal impairment to treat osteoporosis? 
Link  Can acitretin be given to patients with renal impairment or patients on renal replacement therapies? 
Link  Intravenous fluorescein in renal impairment or renal replacement therapy 
Link  Can patients with renal impairment take glucosamine? 
Link  What is the available evidence for the use of statins in patients with renal impairment?  
Link  Are LMWH preferred to unfractionated heparin in people with RI being treated for VTE and MI?
Link  Should prophylactic doses of LMWHs be used in patients with renal impairment?
Link  Which opioids can be used in renal impairment?
Link  What is the first choice antidepressant for patients with renal impairment?
Link  Can oseltamivir be used in adult patients with renal impairment?
Link  Can oseltamivir be used in adult patients on renal replacement therapies?
Link  Can zanamivir be given to patients with renal impairment or on renal replacement therapy?