A Concise Overview of Important Information for Avoiding Adverse Drug Events—Your Kidney Function—

A Concise Overview of Important Information for Avoiding Adverse Drug Events—Your Kidney Function—

There are a number of things to be concerned about when you or a loved one are taking medications, whether they are prescription or OTC. Your pharmacist might not be informing you all of these things.

To give just one example, it's common knowledge that taking multiple medications at once can lead to dangerous interactions. Also, the majority of people are aware that drug allergies are a real threat. This is covered in previous entries in the series. A increased risk of adverse medication events may occur in very young children, very old individuals, pregnant women, nursing mothers, and seriously disabled people, as is well known.

Unfortunately, most people are unaware that a simple blood test can be a crucial piece of information for many medications' proper dosage calculations. What's even more frustrating is that your pharmacist will likely not have access to these test results, particularly if they fill your prescription at a retail drugstore. (And I'm sorry about that.)

Obviously, I'm referring to the "serum creatinine test" (pronounced "SEAR-em cree-AT-tuh-neen tehst"). No one has to be in the dark about this test—which is both challenging to pronounce and understand—if they or someone they care about is taking any kind of drug, whether it's over-the-counter or prescription.

The serum creatinine level provides a rough indication of renal function to the doctor or pharmacist.

The 'bean counter' of contemporary medicine, serum creatinine indicates whether the kidneys are functioning optimally.

In what ways does that matter?

Since the kidneys (together with the liver) aid in the elimination of drugs from the body, their function is very crucial in determining the correct doses of many medications.

It is quite likely that the kidneys and liver will act in tandem to eliminate the majority of drugs and their chemical by-products.

To put it another way, when the beans aren't doing their job, the body will amass a lot of drugs, which might lead to dangerous adverse effects. And that's much more disappointing. (Another piece in this series will address this same topic; it pertains to liver issues as well.)

Consequently, many drugs require lower doses in people with impaired kidney function.

Then how exactly does it function?

In any case, creatinine is a naturally occurring and circulated molecule in humans. The outcome of typical protein degradation is this. Additionally, the beans typically eliminate creatinine from the blood, as is the case with many drugs. Creatinine levels in the bloodstream rise in response to impaired kidney function, as they do in response to many drugs.

Results from a serum creatinine test are commonly and easily used by doctors and pharmacists to detect blood creatinine levels. Including this test in a battery of blood tests is not uncommon. A reduced dose is required for several medications when serum creatinine levels are high. Serum creatinine levels typically range from 0.4 to 1.5 mg/dl, however this range can differ slightly across laboratories.

Serum creatinine levels should rise since the kidneys aren't working.

Although there are more precise ways to gauge kidney function, serum creatinine is often the go-to for estimations because it is easy to obtain, doesn't cost much, and provides results that are sufficiently accurate for most applications.

The term "creatinine clearance" (cree-AT-tuh-neeeen CLEAR-uhhh-nce) describes the most reliable method currently used to assess renal function. Unfortunately, hardly many patients opt for this specific test due to its unpleasantness and discomfort. For the next 24 hours, you must collect and store all of your pee in the fridge. Scarcely anyone has offered to take this test...

The amount of creatinine that the kidneys remove from the blood in a specific amount of time is called creatinine clearance, and it is often expressed in milliliters per minute.

Creatinine clearance, or the quantity of blood that the kidneys are effectively "cleaning," falls as a result of impaired kidney function.

"Kidneys no work...creatinine clearance go DOWN" is good to keep in mind. Keep in mind that this goes against your initial assumptions and the way serum creatinine works, so it's easy to remember. This is the norm in the medical field.

For those who are determined to get an A, here is the extremely challenging portion. Wow, it's quite cool that serum creatinine can be used to "guesstimate" creatinine clearance. In the absence of a measured creatinine clearance, that is likely the most accurate method for assessing renal function.

One way to evaluate renal function is to run the serum creatinine value through a complex calculation. This will give you the estimated creatinine clearance. (I thrive in rigorous scientific environments where there are estimates of estimates of estimates.)

The infamous "Cockcroft-Gault equation corrected for ideal body weight and gender" exists for adults, and it's a formula that everyone despises. Because it has never been adequately validated in young patients, old patients, thin patients, fat patients, or any other kind of patient, the Cockcroft-Gault equation (probably named after Drs. Cockcroft and Gault, but it could also be shortened to Dr. Cockroft-Gault or Lara Croft) is widely believed to be very reliable. So, sort it out. Remembering this will earn you double bonus points:



A man's creatinine clearance is equal to

((140 - Age)\' IBW) / (72'SCr)



A woman's creatinine clearance is equal to

/ (72'SCr) * ((140 - Age)'IBW'0.85)



Here, SCr stands for serum creatinine and IBW for ideal body weight in kilograms, with Age denoted in years.

(Check out this creatinine clearance calculator if you're having trouble with algebra or just want some help figuring out the answers to these tricky questions:) The website medicationadvisor provides information about creatinine.

It turns out that young, healthy persons have a creatinine clearance of around 100 ml/min (for the rest of this, we'll just ignore the'ml/min' bit).

Additionally, the creatinine clearance of a healthy person when they die is approximately zero.

Everybody else is a little bit of a mixed bag.

("I just did this on myself and my creatinine clearance is 150," someone says from behind the scenes). You are unique, aren't you? Actually, it's not really helpful as 100 is totally okay, and young attractive people can have creatinine clearances of 130, 140, or even more. Actually, it's simply another instance of someone going above and above.

A creatinine clearance of 80 indicates that the kidneys are functioning at an 80% level.

By the way, 50% renal function is indicated by a creatinine clearance of 50%. (Have you been paying attention?).

Once renal function falls into the 40-60 range, patients taking medications that are excreted by the kidneys will need to moderately decrease their dosage.

Patients in the 20–40 age group usually necessitate substantial dosage decreases.

And patients in the "less than 20" range typically require significantly lower doses of drugs that are excreted by the kidneys (or, even better, they should take drugs that are excreted by another organ entirely, if that is an option).

Just one more thing to think about. With age comes a decrease in renal function. It cannot be avoided. However, everyone's rate of decrease is unique. You should expect to have intermediate renal function (or worse) by the time you're 50 years old. By the time you're 80 years old, you'll almost surely have some significant degree of renal impairment... and you might not even be aware of it or feel it.

You have learned more about renal physiology than you ever dreamed possible. Alright, let's return to the point of this article: pharmaceutical safety.

Your doctor and pharmacist probably didn't have renal function data on hand or didn't take it into account when they prescribed you medication, so it's on you to take charge and ensure that you or someone you care about doesn't experience diminished kidney function. I'll reveal who these people are in a moment.

Everyone who takes medication, whether it's a prescription or an OTC, should follow these steps:

1) Everyone should commit the results of a recent serum creatinine test to memory or write them down. When prescribed medication, inform your doctor or pharmacist, "I believe my serum creatinine is about X." This information is typically included in yearly physicals, so it's easy to find. To ensure my safety, is there a specific dosage that this drug must be taken?

2) Prior to drug administration, your doctor and pharmacist should have taken your renal function into account if you fall into one of the following categories:has a history of renal illness;older than fifty years old;a history of cardiovascular disease, including but not limited to: heart attacks, angina, strokes, and other vascular blocking events;present or past diagnosis of diabetes;a history of hypertension;history of chemotherapeutic drug exposure;a history of long-term intravenous antibiotic use;regularly using painkillers (particularly NSAIDs, although not limited to them).



If you're concerned about the potential impact on your kidney function due to a medical condition, you might ask your doctor or pharmacist, "Is this drug removed by the kidney?" If the drug is eliminated by the kidneys, you might also inquire about your serum creatinine level with your doctor or pharmacist. If they do not know this, it should raise serious concerns.

No need to fret if you do not fall into any of the groups listed in question 2 and a serum creatinine is not readily available. Probably you won't be hurt. On the other hand, you should inquire with your doctor about the presence and type of serum creatinine in your medical record.

4) Serum creatinine isn't really helpful for drug dosages if you're on dialysis. Simply let your doctor and pharmacist know that you're on dialysis, and you might want to inquire, "Now is this the usual dose for someone on dialysis?"

To ensure that you or a loved one are receiving the correct dosage of any medication, whether it is prescribed or purchased over-the-counter, I hope that you will take these measures into consideration the next time you need to do so.


Oh my goodness!

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