Medication Dosing and Kidney Disease

Healthcare professionals use two simple tests to check your kidney health: a blood test known as the estimated glomerular filtration rate (eGFR) and a urine test known as the urine albumin-creatinine ratio (uACR). The eGFR test is important for medication dosing, as it helps show how well your kidneys are filtering blood. 

When making decisions about medication doses, your healthcare team may look at your:

• eGFR
• Age
• Weight and body size
• Other health conditions
• Other medications you are taking

Each medication’s prescribing information often includes recommendations for people with low kidney function. Remember, not every medication requires a dose adjustment. 

For many years, healthcare professionals often used a calculation called the Cockcroft-Gault equation to help guide medication dosing in adults. This equation was developed in the 1970s using information from a small group of men.

More recently, newer eGFR equations have been developed from larger and more diverse groups of people and do not include race as a factor. Today, most laboratories automatically report eGFR when kidney function is checked. 

Most eGFR results are reported using a standard body size. This helps make eGFR a useful tool for diagnosing and staging chronic kidney disease (CKD). However, people come in many different shapes and sizes. Medication doses are based on how much kidney function a person actually has. So, healthcare professionals may adjust your eGFR result to account for your body size when making medication dosing decisions. This provides a better estimate of the kidney function you have available to clear medications from your body.

As research has advanced, many healthcare organizations, health systems, and medication experts have moved toward using race-free eGFR as the preferred standard to help guide medication-related decisions in adults.

Sometimes, kidney function can get worse suddenly. This is called acute kidney injury (AKI). Some causes of AKI include:

• Severe illness
• Dehydration
• Infection
• Sepsis
• Surgery
• Certain medications

During AKI, your healthcare team may:

• Lower the dose of some medications
• Stop certain medications temporarily
• Monitor your kidney function more closely

These changes are often temporary. Once your kidney function improves, medications may be restarted or adjusted again. Always ask your healthcare team before stopping any medication.

• What is my current eGFR?
• Based on my kidney function (eGFR), do any of my medications need dose adjustments?
• Are the medications I am taking safe for me at my current eGFR?
• What side effects should I be aware of based on the medications I am taking?
• When do you recommend checking my eGFR again?

• Safe Medicine Use with Chronic Kidney Disease
• How Your Kidneys Work
• Estimated Glomerular Filtration Rate
• NKF Medicines and Kidney Health Hub