Kidney disease prescribing information “too vague”
Prescribing information for health care professionals treating patients with kidney disease is too vague, concludes the latest issue of the Drug and Therapeutics Bulletin.
The DTB reviews methods for identifying and classifying chronic kidney
disease in adults and sets out the implications of the disease for patients’ health.
It also offers advice on prescribing for patients with chronic kidney
disease.
It suggests that information provided in summaries of product characteristics
(SPCs) can be unhelpful, stating that drugs should be used “with
caution” in patients with kidney disease without explaining what
that means in practice, but it reminds prescribers that they can seek
guidance from local medicines information services and from specialist
pharmacists.
Andrea Devaney, lead renal pharmacist at the Oxford Radcliffe Hospitals
NHS Trust and a committee member of the UK Renal Pharmacy Group, commented: “I
would support and encourage, on behalf of the UK Renal Pharmacy Group,
the authors’ advice for prescribers to contact specialist renal
pharmacists for further guidance on drug dosing in renal impairment.”
She added that new chronic kidney disease guidelines and national reporting
of estimated glomerular filtration rate (eGFR) values will improve recognition
of the condition. “But caution must be applied when extrapolating
eGFR values for drug dosing. Most published reference texts recommend
doses based on non-normalised estimates of GFR (Cockcroft and Gault estimates).
In practice, I believe, Cockcroft and Gault will remain the gold standard
for dosage adjustment in chronic kidney disease until such a time as
reference tests recommend doses based on GFR normalised for body size.
“The ‘Renal drug handbook’ goes some way to fill the
dosing gaps highlighted by the authors in SPCs and the BNF since it includes
practical, anecdotal dosage recommendations often based on experience
from the front line.” |
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