Impaired renal clearance of medications

[RightSide]

One very annoying part of coping with ESRD is discovering how many medications that used to be perfectly safe for me to take are now problematic, because of impaired renal clearance.

In hospitals, I've been given sedatives and anesthetics that took 20 hours to clear, because the doctors forgot that those meds are cleared through the kidneys; leaving me zonked for most of a day.

Even for such simple things as having a tooth pulled or treating a skin infection or helping me sleep, oftentimes a doctor will prescribe a medication--after I told him I've got kidney failure--and then it turns out that the medication is cleared through the kidneys and can last too long or even build up to toxic levels.  (Fortunately my pharmacist is good at catching those kinds of things.)

Anyway, it's a real problem.  Doctors can't know the pharmacology of every single medication. And in my case at least, they've made several mistakes--prescribing meds that are known to be cleared through the kidneys.  And because I've lost 90% of my kidney function, the meds stay in my bloodstream for a VERY long time, causing me nasty side effects.

At home, I can log onto the Internet and check up on the meds I've been prescribed. But in a hospital setting or as an outpatient in a doctor's office, I can't do that.

[tyefly]

what kind of medications are passed by the kidneys.......   what are their names........ I wonder if I am or have taken any and didnt know.....

[monrein]

Excellent point Rightside.  A good reminder to ask about how a medication is metabolized when it's prescribed and insist that the info be checked before we get it into our bodies.

[texasstyle]

It's great that you brought some attn to this. Everything has to cleared by the doctor now before you take it. And reading labels is now impearative! even something a "simple" as a cold med, can raise your blood pressure to very high levels.

[peleroja]

I'm a little confused.  Whenever my neph prescribes a new med for me, he always checks his little book to see whether it is safe for a renal patient and in what dosage.  Even my primary doc checks her book.  Who is it that is prescribing for you without checking?

[billybags]

I know what you mean about different meds, I always question if they are ok, you never know. I only let my husband take, for instance, paracetamol, not ibrabrufin or that type of pain killer, cough mixtures are another thing. We could go on all day, as you say the docs do get it wrong some times. be wary always ask..

[Sunny]

Always remind any doctor,nurse,or dentist that you are renal impaired. There are some meds they cannot prescribe because of it,and other meds must have a lower dosage according to GFR. A physician's handbook always informs about these issues and any good medical practitioner who knows your circumstances would check. If you end up in a hospital where people don't know you, constantly remind the nurses and doctors, because sometimes they fail to adequately read your chart.I have ended up in ER many times over the years and have been so out of it I have forgotten to remind medical people of my low renal function. My husband never forgets and always mentions it over and over and over again to any person trying to give me any medications. At this point in my life, I have finally become just as diligent.

[aharris2]

I'm a little confused.  Whenever my neph prescribes a new med for me, he always checks his little book to see whether it is safe for a renal patient and in what dosage.  Even my primary doc checks her book.  Who is it that is prescribing for you without checking?

Our neph always checks his book, the pcp checks with the neph, as does the dentist. We always check online. But, there are times when one runs into new docs - specialists, and worst of all, in the hospital. In spite of our diligence, we have had a couple of very bad experiences from overmedication. In both cases, we were unable to check the meds in a timely manner. It has been a while. Now, even in the hospital, we have internet access, allowing us to check up on any med being offered.

We are vocal always. We make it known that my brother is a dialysis patient before any procedure. As an illustration of the problem, according to our neph, there is one anesthesia that should never be used on a renally impaired patient. (I can't remember its name right now.) On more than one occasion that medication was offered to us. We refused it. The very unhappy anesthesiologist said that he had never heard such a thing... but he did change the anesthesia to be used.

I do trust the neph and I trust our ability to do the research, given the opportunity. It is very important to be your own advocate.

[sullidog]

So far I've not had problems clearing anasthetics, maybe it's the kind they use? Something else I want to mention is with any antibiodic that you take daily, my neph tells me to just take it every other day because the dialysis will clean it out, is this a rule to go by?
Troy

[RightSide]

Our neph always checks his book, the pcp checks with the neph, as does the dentist. We always check online. But, there are times when one runs into new docs - specialists, and worst of all, in the hospital. In spite of our diligence, we have had a couple of very bad experiences from overmedication.

Yep, that's one of the problems I've had.

Another is that now I have to deal with both the impaired renal clearance issue and the drug interaction issue.

For example, since I'm allergic to penicillins and cephalosporins, my oral surgeon prescribed me the antibiotic Biaxin.  He knew that clearance of Biaxin from the body is much slower with ESRD patients--the half-life is much longer.  He told me "Don't worry, it will all be out of your system by midday tomorrow." 

The problem is, my neph had put me on Trazodone as a sleep aid--and when I take the Trazodone at bedtime this evening, enough of the Biaxin is still in my bloodstream to interact badly with the Trazodone.  (Biaxin will double the half-life of Trazodone, and I don't want to oversleep tomorrow.)  So I ended up taking only half my usual Trazodone dose.  My oral surgeon didn't know I was on Trazodone--in fact, he never asked me for a complete meds list.  I would have brought one with me if I knew this was going to happen.

I'm now on twelve different medications, and dealing with all this is a pain in the neck.