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Semin Dial. 2015 Jul-Aug;28(4):325-9. doi: 10.1111/sdi.12374. Epub 2015 Apr 8.

A Synopsis of Clinical Pharmacokinetic Alterations in Advanced CKD.

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Center for Clinical Pharmaceutical Sciences, Department of Pharmacy and Therapeutics, School of Pharmacy, Renal-Electrolyte Division, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.


Unrecognized alterations in pharmacokinetics, which quantitatively describes the time course of drug disposition in the body, may lead to clinically significant changes in systemic exposure and corresponding response to drugs in patients with chronic kidney disease (CKD). Clinicians must take pharmacokinetic changes into consideration when selecting and dosing medications in CKD patients to optimize the risk:benefit ratio. Pharmacokinetic changes in absorption, distribution, and renal clearance are well characterized and generally predictable for most drugs. Conversely, changes in nonrenal clearance are less well understood and corresponding clinical implications are still being elucidated. This review provides a synopsis of alterations in each of these pharmacokinetic parameters observed in patients with advanced CKD.

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