SPS resources
SPS provides advice on Medicines Monitoring (SPS page), which may be useful to consider when assessing kidney function for people taking specific medicines included in the Tool.
Advice on Using food supplements (SPS page) and Managing complementary products and conventional medicines (SPS page) may help with considering the impact of these products on kidney function.
Other resources
In addition to our own resources, we recommend the following. They are free to access unless otherwise indicated.
Resources are listed in the likely order they would be used. However, this depends on the nature of the question you are looking to answer.
Local formulary or guidelines
Your local Area Prescribing Committee, Medicines Management Group or similar body may have relevant guidelines or documents on their website. For example, guidelines on prescribing in people with chronic kidney disease (CKD) and shared care protocols.
In secondary care, consult Trust policies and guidance.
Local renal services
For questions relating to the care of specific individuals, it can be helpful to contact their specialist renal team or the dialysis unit depending on the advice required.
NICE Clinical Knowledge Summaries
Clinical Knowledge Summaries (CKS) provide advice on renal impairment for primary care practitioners. Topics include:
- Acute kidney injury (AKI) guidance which covers medicine related causes, management and prevention advice
- Chronic kidney disease (CKD) guidance which covers management advice and prescribing information
NICE Guidelines
Relevant NICE Guidelines include:
- Acute kidney injury: prevention, detection and management
- Chronic kidney disease: assessment and management.
Summaries of Product Characteristics (SmPCs)
SmPCs are available via the electronic Medicines Compendium and MHRA. Useful SmPC sections are:
- posology and method of administration (section 4.2)
- contraindications (section 4.3)
- special warnings and precautions for use (section 4.4)
- interaction with other medicinal products and other forms of interaction (section 4.5)
- undesirable effects (section 4.8)
- pharmacokinetic properties (section 5.2)
Licensed information on the use of the medicine in individuals with renal impairment can be found in the product SmPC.
British National Formulary (BNF)
The BNF includes a section on prescribing in renal impairment.
Individual monographs provide a brief statement on the use of the medicine during renal impairment. Estimated glomerular filtration rate (eGFR) is usually used to express kidney function in the medicine monographs.
The BNF is rarely used as a sole information source for managing medicines in renal impairment.
Renal Drug Database (RDD) and Renal Drug Handbook
The Renal Drug Database is available online to subscribers. The Renal Drug Handbook can be purchased, but the Database is the preferred format and updated more regularly.
Individual medicine monographs provide guidance on areas including clinical use, doses in renal impairment, doses in renal replacement therapy, metabolism and administration.
Dose recommendations may be based on specialist experience or use in clinical practice rather than published evidence. Doses advised may therefore differ from licensed doses. Guidance on dose adjustments in renal impairment for this resource is based on creatinine clearance (CrCl) calculated using the Cockcroft-Gault equation.
If using the RDD or Handbook for information, you should also consult the licensed information in the product SmPC. Where advice from the resources differ, use your clinical judgement to determine the most appropriate dose to choose for an individual.
Guidance from the RDD or Handbook could be useful to consider in some individuals. For example, where using a medicine in renal replacement therapy or when prescribing a narrow therapeutic index medicine. If there is no licensed information to support the use of a medicine for an individual with renal impairment, the RDD may provide further advice from clinical experience.
UK Kidney Association (UKKA)
The UKKA is a professional body which provides guidance on caring for people with kidney disease. Resources include:
- AKI Guides
- an eCKD Guide
- UKKA Clinical Practice Guidelines
UK Renal Pharmacy Group (RPG)
The UK RPG, which is part of the UKKA, have a set of leaflets summarising advice on the key aspects of renal impairment. Topic areas include medicines optimisation in AKI, medicine dosing in renal impairment and dialysis, and managing complications and controlling symptoms in CKD.
Royal College of General Practitioners (RCGPs)
The RCGP have produced an AKI Toolkit. This provides guidance on the recognition, response and management of AKI, including medicines optimisation.
Further advice
If the information is not available on the SPS website or in the resources listed, or if your clinical scenario is complex, we suggest you seek further advice from our Medicines Advice service. This service is available for healthcare professionals working in NHS primary care, including community pharmacy, in England.
In secondary care, you may be able to seek advice from your Trust Medicines Information service or a specialist pharmacist.
Patient resources
We recommend the following resources for patients:
NHS
The NHS provides more information for patients about AKI and CKD.
National Kidney Federation (NKF)
The NKF is a charity run by individuals with kidney disorders and provides useful information for people with kidney disorders. The NKF Helpline, and Helpline Information Leaflets are useful resources to provide support for individuals and their carers.
Training resources
If you would like more information on how to approach answering questions on the use of medicines in renal impairment, we recommend:
Medicines Learning Portal (MLP)
The MLP is aimed at trainee hospital pharmacists but the content is also relevant to clinical primary care healthcare professionals. The portal includes a renal tutorial which provides advice on:
- questions to ask when considering queries relating to renal impairment
- medicines and the kidney
- assessing renal function
- renal replacement therapy
- after a renal transplant
- medicines that impair kidney function
Update history
- Republished
- Full review and update. Title updated.
- Title amended
- Published