Drug Dosing Consideration in Patients With Acute and Chronic Kidney Disease

A Clinical Update From Kidney Disease: Improving Global Outcomes (KDIGO)

Gary R Matzke; George R Aronoff; Arthur J Atkinson Jr; William M Bennett; Brian S Decker; Kai-Uwe Eckardt; Thomas Golper; Darren W Grabe; Bertram Kasiske; Frieder Keller; Jan T Kielstein; Ravindra Mehta; Bruce A Mueller; Deborah A Pasko; Franz Schaefer; Domenic A Sica; Lesley A Inker; Jason G Umans; Patrick Murray

Disclosures

Kidney Int. 2011;80(11):1122-1137. 

In This Article

Conclusions and Perspectives

The discussion of the large body of evidence by the conference participants clearly indicates that there have been significant advances in knowledge of the influence of kidney function and RRTs on drug disposition during the past 30 years. The clinical practice recommendations were made to help guide clinicians and will hopefully serve as stimuli for the establishment of further standards of practice for the enhancement of patients' clinical outcomes.

It was also clear that there were significant gaps in knowledge of the PK and PD of most drugs in AKI and CKD patients. As such, establishment of a research agenda was a focus of much of the conference. Furthermore, the evolution of RRTs mandates the inclusion of a higher level of rigor in future investigations so that the quality of the data is improved and its clinical utility enhanced. Indeed, much of the data that are currently available are now only of historical value. The challenge is that there is no obvious source of funding for such research activities. These questions are not hypothesis driven, and thus not generally the basis for investigator-initiated grants. Industry supports much of the research that goes into the development of new drugs, but there is no mechanism at present for funding postmarketing studies in patients with kidney function impairment, especially those with AKI who are receiving CRRT. Recognition of funding sources is an important step in addressing many of these issues.

The regulatory recommendations were considered critical to the conference process as in many cases the quest to better understand the drug dosing needs of AKI and CKD patients is driven by drug-approval agency expectations of the pharmaceutical and biotechnology industry. The KDIGO Controversies Conference highlighted the gaps but more importantly focused on crafting paths to the future that will stimulate research and improve the global outcomes of patients with kidney injury and disease.

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