Medication Management in Chronic Kidney Disease

Chronic kidney disease (CKD) presents unique challenges for pharmacotherapy due to impaired renal clearance, altered drug pharmacokinetics and a high burden of comorbidities. Effective medication management aims to slow disease progression, control complications such as hypertension, anaemia and mineral–bone disorder, and reduce the risk of adverse drug events. Core strategies include dose adjustment guided by estimated glomerular filtration rate (eGFR), regular multidisciplinary medication reviews, targeted deprescribing of potentially inappropriate drugs and patient education to support adherence. Clinical pharmacists play a pivotal role in identifying drug-related problems, ensuring guideline concordance and enhancing patient knowledge. Emerging decision-support tools, including ontology-based prescription systems, promise further personalisation by integrating real-time kidney function measures with drug–drug interaction alerts. Globally, standard protocols advocate renin–angiotensin system blockade, blood pressure targets tailored to CKD stage and careful selection of glucose-lowering agents, balancing efficacy against the risk of hypoglycaemia and other complications.

Research from Nature Portfolio

Recent studies have quantified the prevalence and impact of inappropriate dosing of glucose-lowering agents in CKD. A large-scale retrospective analysis of outpatient visits found that nearly one third of prescriptions lacked dose adjustment for patients with eGFR below 50 mL/min/1.73 m², resulting in a 1.5-fold higher incidence of hypoglycaemic events compared with appropriately dosed regimens. These findings highlight the necessity of integrating renal function thresholds into prescribing workflows and support the implementation of systematic reviews of antihyperglycaemic regimens in ambulatory nephrology care.

Medication Management in Chronic Kidney Disease publication trend

The graph below shows the total number of articles in medication management in chronic kidney disease across all publications each year (not limited to Nature Index journals).

Technical terms

Estimated glomerular filtration rate (eGFR): A calculated index of kidney filtration capacity based on serum creatinine, age and sex, used to stage CKD and inform dose adjustments.

Polypharmacy: Concurrent use of multiple medications, often defined as five or more, which elevates the risk of adverse interactions and nonadherence.

Drug-related problem (DRP): Any event involving drug therapy that interferes with desired health outcomes, including dosing errors, drug–drug interactions or inappropriate medication choice.

Deprescribing: A systematic process of dose reduction or medication withdrawal aimed at minimising polypharmacy and adverse effects while preserving therapeutic benefit.

Clinical pharmacist intervention: Actions by a pharmacist—such as medication review, dose modification or patient counselling—to optimise therapeutic regimens and prevent medication-related complications.

References

1. Effect of pharmacist interventions in chronic kidney disease: a meta-analysis. Nephrology Dialysis Transplantation (2024).
2. Prevalence and global trends of polypharmacy in patients with chronic kidney disease: A systematic review and meta-analysis. Frontiers in Pharmacology (2023).
3. A drug prescription recommendation system based on novel DIAKID ontology and extensive semantic rules. Health Information Science and Systems (2024).
4. Hypoglycemia risk with inappropriate dosing of glucose-lowering drugs in patients with chronic kidney disease: a retrospective cohort study. Scientific Reports (2023).
5. Drug-related problems in hospitalized patients with chronic kidney diseases and clinical pharmacist interventions. BMC Geriatrics (2023).