Pharmacokinetics: Drug Dosing in Renal Disease

Taipei Medical University via Coursera

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Provider

Coursera
Pricing

Paid Course
Languages

English
Certificate

Certificate Available
Effort

7 weeks, 2 hours a week
Sessions

Self-Paced
Level

Intermediate
Subtitles

English

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Overview

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This course provides a comprehensive foundation in clinical pharmacokinetics as applied to patients with renal impairment. Learners begin with kidney anatomy and physiology, connecting glomerular filtration, tubular secretion, and tubular reabsorption to the concepts of renal clearance and drug elimination. The course then explores acute kidney injury versus chronic kidney disease, including CKD staging, common causes and mechanisms of chronic renal failure, and how progressive loss of renal function alters drug handling over time. Building on this foundation, learners practice estimating renal function using serum creatinine, creatinine clearance calculations, and interpretation of eGFR. You will calculate renal clearance using excretion‑rate and urinary‑recovery methods and relate these to total body clearance. The course then focuses on practical dosing: adjusting doses and dosing intervals based on creatinine clearance/eGFR and drug-specific guidelines, with special emphasis on drugs with narrow therapeutic indices and predominantly renal elimination. You will apply therapeutic drug monitoring concepts in renal dysfunction, recognize and prevent drug-induced nephrotoxicity, and manage nephrotoxic reactions when they occur. Finally, the course examines how dialysis affects pharmacokinetics, including dialysability determinants and differences among modalities, and guides you in selecting and timing drug dosing for patients on hemodialysis or peritoneal dialysis, as well as designing comprehensive pharmacotherapeutic plans for chronic renal failure and its key complications.

Syllabus

Renal Excretion in ESRD

Module 1 introduces the physiological mechanisms of renal drug excretion, detailing the nephron functions of filtration, secretion, and reabsorption. It focuses on the quantitative assessment of kidney function through Glomerular Filtration Rate (GFR) and clinical biomarkers such as serum creatinine, Blood Urea Nitrogen (BUN), and Cystatin-C. The text explains how to estimate creatinine clearance using standardized mathematical models, specifically the Cockcroft-Gault and MDRD equations for adults, and the Schwartz formula for pediatric patients. Additionally, it establishes the diagnostic criteria for staging chronic kidney disease based on GFR. Finally, the module demonstrates how to derive renal clearance values using both the excretion rate method and the urinary drug recovery method.

Dosing Regimen and TDM in Renal Failure

Module 2 examines the effects of renal failure on drug pharmacokinetics, specifically analyzing changes in absorption, distribution, metabolism, and excretion (ADME). It details the principles for adjusting dosing regimens in renally impaired patients using elimination rate constant (K) ratios, mathematical equations, and clinical nomograms. The module demonstrates how to calculate individualized initial and maintenance doses through practical case studies, including tobramycin and digoxin. Finally, it emphasizes Therapeutic Drug Monitoring (TDM) strategies to ensure clinical efficacy and prevent toxicity for narrow-therapeutic-index medications

General cases for patients with renal failure

Module 3 focuses on the clinical application and pharmacokinetic management of aminoglycosides and vancomycin in patients with renal impairment. It compares their antimicrobial profiles and highlights their shared risks of nephrotoxicity and ototoxicity, underscoring the necessity of Therapeutic Drug Monitoring (TDM). The module demonstrates how to calculate patient-specific pharmacokinetic parameters, such as the elimination rate constant k, volume of distribution ($V$), and renal clearance, using intermittent infusion equations and plasma concentration data. Furthermore, it applies these concepts to clinical case studies, illustrating the process of determining individualized loading doses, maintenance regimens, and appropriate dosing intervals to safely achieve target peak and trough concentrations.

Dosing Regimen in Renal Dialysis

Module 4 examines the principles of renal dialysis and its pharmacokinetic implications for drug dosing in End-Stage Renal Disease (ESRD). It outlines the primary dialysis modalities, including hemodialysis and peritoneal dialysis, alongside vascular access methods such as A-V fistulas. The module focuses on the quantitative assessment of dialysis clearance (dialysance) using the Arteriovenous (A-V) difference method and the dialysate method. Furthermore, it details the pharmacokinetic factors that determine a drug's dialyzability, such as molecular weight, protein binding, and volume of distribution. Finally, it summarizes the general principles for dosing adjustments in dialysis patients, including the timing of supplemental doses and the application of hemodialysis in managing specific drug overdoses.

Pharmacokinetics and Drug Dosing in Renal Impairment

This module addresses Acute Renal Failure (ARF), exploring its clinical definitions, epidemiology, and underlying risk factors. The module classifies ARF into pre-renal, intrinsic, and post-renal azotemia, detailing the distinct pathophysiological mechanisms for each category. It highlights the critical role of drug-induced nephrotoxicity, identifying high-risk agents such as aminoglycosides, contrast media, and NSAIDs. Furthermore, the module evaluates comprehensive management strategies, including preventive hydration protocols, pharmacological interventions utilizing loop diuretics, and the management of ARF-related complications. Finally, it reviews the specific clinical indications—using the AEIOU criteria—for initiating dialysis in acute settings.

An overview of Chronic Kidney Disease

Module 6 addresses the pathophysiology and clinical management of Acute Renal Failure (ARF) and the therapeutic approaches for chronic kidney disease (CKD) complications. It delineates the classification of ARF into pre-renal, intrinsic, and post-renal types to determine appropriate diagnostic and treatment pathways. The module also focuses on the management of hyperphosphatemia and renal osteodystrophy through the application of various phosphate binders and calcium therapies. Furthermore, it details the protocols for managing renal anemia, including the assessment of iron stores and the monitoring of erythropoietin therapy to achieve goal hemoglobin and hematocrit levels.

Final Review

This assessment evaluates cumulative understanding of clinical pharmacokinetics across all six modules of the course and is designed to assess the ability to integrate and apply key pharmacokinetic concepts in clinically relevant situations. It requires learners to demonstrate overall mastery of core principles and their application to patient care, including the interpretation of drug concentration data and the use of pharmacokinetic reasoning to support safe and effective dosing decisions.