Dose Adjustment of Renally Eliminated Drugs in Patients with CKD

Chronic kidney disease (CKD) significantly alters the pharmacokinetics of many medications, especially those primarily eliminated by the kidneys. Inadequate dose adjustments in CKD patients can lead to drug accumulation, toxicity, or reduced therapeutic efficacy. This article focuses on the clinical principles and practical approaches to dose adjustment of renally eliminated drugs in patients with CKD. We review key pharmacokinetic parameters affected by impaired renal function, methods for assessing kidney performance—including estimated glomerular filtration rate (eGFR) and creatinine clearance—and current dosing guidelines. Special emphasis is placed on high-risk drug classes such as antimicrobials, anticoagulants, and antidiabetic agents. The role of clinical decision support tools and interprofessional collaboration in optimizing drug therapy is also discussed. Appropriate dose adjustment is critical to minimize adverse effects and enhance therapeutic outcomes in patients with CKD. By aligning pharmacological strategies with renal function, clinicians can improve patient safety and treatment precision.