Questions to ask when giving medicines advice in renal impairment

To understand the person’s overall health:

• get the person’s age, gender, height and recent weight
• ask about any other medical conditions that may affect the choice of medicine or dose, for example heart failure or diabetes
• establish their body composition and muscle mass, for example, identify if they are elderly, an amputee, a body builder or have a muscle-wasting disorder

Find out if the person:

• has an established kidney disease
• is under the care of a renal (or other) specialist, in case changes to medicines are needed
• has any complications of CKD, for example any symptoms such as leg swelling, itching, or restless legs syndrome

To understand the nature and extent of any renal impairment you should:

• read Calculating kidney function (SPS page) for guidance on obtaining an individual’s current measurement of kidney function
• see if the individual’s kidney function is different from previous measurements to determine if it is stable or changing
• establish the presence and type of any kidney function disorder, for example AKI or CKD
• identify any medicines suspected of causing the renal impairment, for example, non-steroidal anti-inflammatory drugs (NSAIDs), diuretics or aminoglycosides
• know if the person is on RRT, find out which type, how often and where they have it
• understand whether individuals on dialysis have any residual kidney function, and any medicines they are taking to help preserve it

Do not assume that people with kidney transplants have normal kidney function.

Undertake a full medication history to establish:

• any current medicines, doses and frequencies
• if the person is currently taking the medicines as prescribed
• if medicines are being taken, are they effective and is the person experiencing any side effects
• any use of food supplements, over the counter medicines or complementary products

If you are thinking about recommending an alternative to their current medicine, you may want to consider:

• if any alternatives have already been considered or tried
• the preferred medicine and dose that would be used if the person did not have renal impairment
• whether the individual’s renal specialist needs to be consulted

Once you have collected as much information as you can, look at our article on Renal impairment: resources to support clinical decisions (SPS page).

Use the information gathered to decide if the medicine is appropriate and safe to use, and if any dose changes are required.

If additional medicines monitoring is needed, refer to our advice on Medicines Monitoring (SPS page). Consider whether the person needs to be monitored for additional side effects.

Consider the nephrotoxic potential, side effects of any medicines and any drug interactions between them.

Seek further advice from the individual’s renal specialist or contact the SPS medicines advice service (SPS page) when:

• no information for the medicine in renal impairment can be found
• the clinical scenario is complex
• you have doubts and require a second opinion

This service is available for healthcare professionals working in NHS primary care, including community pharmacy, in England.

If you work in secondary care then you can contact your local medicines information service or specialist pharmacist for further advice.