Prescribing in Renal Impairment/Renal Failure
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Avoid medicines that are eliminated via the kidneys or reduce the dose of medicine if no alternative available. Check renal function before prescribing any drug that requires dose adjustment in renal impairment. Estimate the GFR (creatinine clearance) using your electronic calculator on your phone.
Stages of Chronic Kidney Disease (CKD) by GFR:
| Stage 1 | >90ml/min | Normal |
| Stage 2 | 89-60ml/min | Mild CKD |
| Stage 3 | <59-30ml/min | Moderate CKD |
| Stage 4 | 29-15ml/min | Severe CKD |
| Stage 5 | <15ml/min | End Stage CKD |
Medicines in Renal Impairment
For full list see main Zimbabwe STG
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Antibiotics |
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Penicillins/Cephalosporins |
Reduce dose by 50% in advanced failure |
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Aminoglycosides (Gentamicin) |
Use with extreme caution if no alternative. Use loading dose of 1mg/kg gentamicin, then use maintenance dose of 1mg/kg as well, once daily in moderate renal failure and once on alternate days for advanced renal failure. |
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Nitrofurantoin Nalidixic acid Trimethoprim Sulphonamides Cotrimoxazole Tetracycline |
Avoid |
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Doxycycline |
May be used safely |
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Anti-TB medicines |
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Ethambutol Streptomycin |
Avoid |
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Pyrazinamide |
Reduce dose by 50% |
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Isoniazid |
Maximum daily dose 200mg |
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Antiretroviral Medicines |
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Abacavir |
Use usual dose |
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Zidovudine |
Reduce dose especially if on dialysis |
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Lamivudine |
Reduce dose (maximum of 150mg daily) |
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Efavirenz |
No need to adjust doses |
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Tenofovir |
300mg following dialysis once a week |
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Lopinavir/Ritonavir |
Use usual dose |
Medicines and Dialysis
Dialysis may remove significant quantities of some medicines, e.g. penicillins, aminoglycosides, cephalosporins, chloramphenicol, metronidazole, anti-TB therapy, quinine. Therefore give supplementary doses following a haemodialysis session. The dialysis team will advise on supplementary doses.