Pharmacokinetics and drug dosing in kidney impairment and dialysis
How reduced kidney function changes absorption, distribution, clearance and response, estimating clearance with Cockcroft-Gault versus eGFR, the dose-adjustment calculation, and which drugs dialysis removes.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Kidney impairment changes every step of pharmacokinetics, but the big effect is reduced clearance of drugs or active metabolites that the kidney excretes.
- Half-life = 0.693 × Vd / CL (clearance and half-life). Halve clearance and the half-life doubles, steady-state concentration doubles on the same dose, and steady state takes twice as long to reach.
- Maintenance doses fall; loading doses mostly don't, because loading depends on volume of distribution.
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Sources
- Australian Medicines HandbookAU/NZAustralian Medicines Handbook Pty Ltd, 2026
- Therapeutic Guidelines: Prescribing in special populations (renal impairment)AU/NZTherapeutic Guidelines Ltd, 2026
- Chronic kidney disease (CKD) management in primary care (5th ed.)AU/NZKidney Health Australia, 2024
- KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney DiseaseKidney International 2024;105(4S):S117-S314, 2024
- Drug dosing consideration in patients with acute and chronic kidney disease: a clinical update from KDIGOKidney International (Matzke et al., 2011;80:1122-37), 2011
- The Renal Drug Handbook (5th ed.)CRC Press (Ashley and Dunleavy, 2018), 2018
- Last updated
- 14 November 2026
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