Renal Dosing Issue

Published

I need major help in understanding medication dosing for Chronic Kidney Disease, especially if the patient is on hemodialysis. If they are in stage 4 - 5 in CKD, then what type of cautions should I take before prescribing medication. Lets look at the drug called Lisinopril in epocrates. Under the section "renal dosing" it says:

"[HTN]

CrCl 10-30: start 5 mg qd, max 40 mg/day; CrCl

So what does no supplement mean? Does it mean I do not have to adjust the dosage?

Also, let's say if a patient is getting dialysis every day for 2 hours, and they are on a medication which requires blood level once in a while. Let's say if that patient is on Depakote 500 mg qday. In Epocrates, it says that this medication does not need supplementation, which I think means it doesn't need to be adjusted like I mentioned above. The serum drug level for this medication should be between 50-100 mcg / ML. Let's say that the patient has been getting dialysis every day for 2 hours, and her Depakote blood level is 75 mcg / ML. Now, how does this level of Depakote fluctuate in relation to hemodialysis? Will the Depakote level rise just before dialysis (if the patient has not been urinating due to CKD) and fall after Dialysis? I am having a hard time giving a clear explanation of my question. I hope its somewhat clear. If not, I'm sure we can have great discussion about this topic.

Up Vote Up Vote ×
+ Join the Discussion