title: Prescribing for older people with chronic renal impairment.
abstract: BACKGROUND
  Renal function is an important prescribing consideration. On average, glomerular filtration rate declines by about 10 mL/min every 10 years after the age of 40. Renal impairment may cause medicines to accumulate or cause toxicity, especially if the medicine has a narrow therapeutic index.
  
  
  OBJECTIVE
  To present an overview of prescribing considerations in the primary care setting for patients with chronic renal impairment.
  
  
  CONCLUSIONS
  Serum creatinine considered in isolation is not a reliable indicator of renal function. The estimated glomerular filtration rate provided in pathology reporting can alert prescribers to possible renal impairment and the need to consider dose adjustments. The Cockcroft-Gault equation should be used to adjust medicine doses. Renal function monitoring is recommended for patients using medicines that can impair renal function or cause nephrotoxicity (eg. NSAIDs, ACEIs, ARBs).
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia.
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell
authors.forename: Natalie
authors.initials: N
authors.lastname: Blacker
authors.forename: V Tammy
authors.initials: VT
authors.lastname: Leblanc
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Alderman
authors.forename: Adam
authors.initials: A
authors.lastname: Phillips
authors.forename: Debra
authors.initials: D
authors.lastname: Rowett
authors.forename: Simone
authors.initials: S
authors.lastname: Rossi
authors.forename: Oliver
authors.initials: O
authors.lastname: Frank
authors.forename: Alan
authors.initials: A
authors.lastname: Husband
mesh_terms: D000368:Aged; D003404:Creatinine / Q000097:blood; D004305:Dose-Response Relationship, Drug; D005919:Glomerular Filtration Rate; D006801:Humans; D004364:Pharmaceutical Preparations / Q000008:administration & dosage / Q000378:metabolism*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000378:metabolism*
chemical_list: D004364:Pharmaceutical Preparations; D003404:Creatinine