Many medicines or their metabolites are eliminated from the body via the kidneys. In renal impairment, these medicines will tend to accumulate, leading to toxicity. Dialysis will replace some of the excretory functions of the kidneys, but is still not equivalent to fully functioning kidneys. It is important to amend doses of renally-excreted medicines according to the patient’s degree of renal impairment, or the type of dialysis they are undergoing. In order to do this, it is necessary to calculate the patient’s creatinine clearance (CrCl), or their estimated glomerular filtration rate (eGFR), and have knowledge of the type of renal replacement therapy the patient is receiving.

If a medicine’s metabolism and/or excretion is unaffected by renal impairment, it may be used at usual doses and the patient should be monitored for signs of increased sensitivity to the effects of the medicine.

High-risk medicines include: