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Individualizing Therapy in Patients With Chronic Kidney Disease

School of Medicine, Division of Nephrology and Hypertension, UNC Kidney Center, University of North Carolina, School of Pharmacy, Divisions of Pharmacotherapy and Experimental Therapeutics and Molecular Pharmaceutics, University of North Carolina, Chapel Hill, North Carolina, melanie_joy{at}med.unc.edu

Mary La

School of Medicine, Division of Nephrology and Hypertension, UNC Kidney Center, University of North Carolina

Bo Xiao

School of Medicine, Division of Nephrology and Hypertension, UNC Kidney Center, University of North Carolina

Patients with chronic kidney diseases have multiple clinical abnormalities that may affect disposition of drugs, including alterations in glomerular filtration rate, excretion of plasma proteins, reductions in serum albumin, and reductions in drug metabolizing enzyme activity. Inflammation may also influence the previous factors. Concomitant drug therapies can lead to drug— drug interactions that may affect the pharmacokinetics of administered drugs. Pharmacogenomics has begun to be evaluated for effects of genotype and haplotype of drug metabolizing enzymes and transporters on drug disposition. Because of the multiple potential etiologies for alterations in drug disposition in patients with chronic kidney diseases, they require appropriate evaluation for implementation of individualized strategies in therapies to enhance efficacy and reduce toxicities. This review will highlight the disease- and patient-specific variables that are targets for patient-centered approaches to therapeutic interventions. The field of pharmacogenomics will be reviewed with reference to common therapies for transplantation and glomerular diseases.

Key Words: chronic kidney disease • individualized therapy • drug disposition

Journal of Pharmacy Practice, Vol. 21, No. 3, 225-236 (2008)
DOI: 10.1177/0897190008315907


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