OVERVIEW: People with chronic kidney disease often live with many illnesses and complex treatment regimens. As the disease progresses, the number of drugs prescribed may increase substantially; by the time a patient is in stage 5, he may be taking 11 or more drugs daily. The effects of the disease on pharmacokinetics (drug absorption, metabolism, distribution, and elimination) and pharmacodynamics (a drug’s mechanism of action and effects at the target site) further increase the potential for adverse drug reactions and drug toxicity. Nurses’ roles in evaluating patients’ responses to drugs and teaching about the risks involved are discussed.
The effects of chronic kidney disease on pharmacokinetics (drug absorption, metabolism, distribution, and elimination) and pharmacodynamics (a drug’s mechanism of action and effects at the target site) increase the potential for adverse reactions and drug toxicity.
Sally Campoy is a clinical preceptor at the University of Colorado Health Sciences Center School of Nursing and a nurse practitioner in the Renal Section, Veterans Affairs Medical Center, Denver, CO, where she serves on the Pharmacy and Therapeutics Committee. She leads the Chronic Kidney Disease Special Interest Group for the American Nephrology Nurses’ Association. Rowland Elwell is an assistant professor of pharmacy practice at the Albany College of Pharmacy, Albany, NY. Contact author, Sally Campoy: firstname.lastname@example.org.
This article is the fourth in a series on chronic kidney disease supported in part by a grant from the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (K/DOQI), which is underwritten by educational grants from Amgen, Bayer Diagnostics, Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership, and Ortho Biotech Products, LP. Sally Burrows-Hudson, MS, RN, CNN (email@example.com), is the series coordinator. Since taking on that role, she has become director of Medical Affairs at Bone Care International in Middleton, WI.
Author disclosures: Sally Campoy has received honoraria and travel expenses for lectures from Amgen (the manufacturer of Epogen, a drug mentioned in this article), Ortho Biotech (the manufacturere of Procrit, a drug mentioned in this article), and Genzyme (the manufacturer of Renagel, a drug mentioned in this article). She has also received honoraria and travel expenses from Amgen for participation in advisory board meetings. Rowland Elwell has received honoraria and travel expenses from Amgen and Genzyme for lectures.