How the reclassification of kidney disease impacts on dosing adjustments

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The Pharmaceutical Journal
Vol 277 No 7420 p403-404
30 September 2006

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Articles

How the reclassification of kidney disease impacts on dosing adjustments

In this article, Andrea Devaney, Caroline Ashley and Charlie Tomson highlight potential problems introduced by the changes to how renal impairment is classified and explain why extra care is needed when working with the new terms

Andrea Devaney is lead pharmacist for renal and transplant services at the Oxford Radcliffe Hospitals NHS Trust and a committee member of the UK Renal Pharmacy Group.

Caroline Ashley is lead specialist pharmacist for renal services at the Royal Free Hospital, London, and chairman of the UK Renal Pharmacy Group.

Charlie Tomson is a consultant nephrologist at Southmead Hospital, Bristol. He chaired the group that developed the UK CKD guidelines.

Correspondence to:
andrea.devaney@orh.nhs.uk

Mike Wyndham Medical Picture Library

Patients with kidney disease

Patients with kidney disease require extra care to be taken when dosage adjustments are calculated

SUMMARY

In 2003 the UK adopted the US Kidney Disease Quality Outcomes Initiative (K/DOQI). This led to a change in the terms used to describe renal impairment. For example, “end stage renal failure” was replaced by “established renal failure” (ERF). There was also a shift from describing the degree of renal impairment as mild, moderate or severe. Instead, the new chronic kidney disease (CKD) guidelines describe the degree of renal function in five stages, with stage 1 indicating near normal renal function and stage 5 indicating ERF or that dialysis is required.

In addition, the CKD guidelines define the measure of renal function as a glomerular filtration rate (GFR), which has been normalised to a body surface area of 1.73m² (the normal mean value for adults).

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