Renal excretion is an important pharmacokinetic parameter for many drugs. Clinical pharmacists carefully monitor patient’s renal function to assess if changes in drug dosing are required to avoid toxicity or maximum efficacy. The kidney do a lot more than excrete drugs, they participate in maintaining fluid and electrolyte balance, acid/base homeostasis, red blood cell production, vitamin production and waste excretion. As kidney function declines into chronic kidney disease (CKD), pharmacotherapy may be employed to partially regulate these homeostatic functions. However, now a patient less able to renally excrete drugs requires a greater number of medications. This is one of the dilemmas that will be addressed during my nephrology rotation. Hemodialysis (HD) may be employed when kidney function declines to a point where medications and life style alone cannot compensate for the loss in filtration. HD also has its limitations and an in-depth understanding of these is required when optimizing drug therapy in these individuals. Something tells me there will be a lot to learn on this rotation.
These are my personal rotation specific goals in addition to those presented on the ROAD document.
- To gain a thorough understanding of common co-morbidities and treatment options in CKD and dialysis patients including but not limited to heart failure, hepatic disease, atrial fibrillation and infection.
- To conduct pharmacokinetic assessment in patients with CKD or on dialysis including vancomycin, aminoglycosides and phenytoin if the opportunity presents.
- To evaluate and form a treatment plan for acid-base disturbances in patients with CKD and on dialysis.
- To evaluate and form a treatment plan for electrolyte disturbances in patients with CKD and on dialysis.