Anyone caring for patients with chronic kidney disease (CKD) is aware of the extent to which pharmaco-therapy is involved in the lives of these patients. Recently, it was reported that hemodialysis patients in one large dialysis system were prescribed a median of 12 different medications at any given time point [1]. This number of medications per patient has not changed in over a decade [2]. As pharmacists who work with CKD patients, we find that drug-related issues are foremost on the minds of these patients. Often these issues extend beyond the medications prescribed by their caregivers and go to over-the-counter medications and alternative or complementary therapies that they are taking without the knowledge of their caregivers.

Substantial morbidity and mortality have been associated with 'medication misadventures' in American patients [3]. and it is likely that this is magnified in CKD patients. The concept of 'drug-related problems' has been put forward to characterize the myriad of issues that can occur with pharmacotherapy in patients with CKD [2]. A pooled analysis of published reports of medication use in hemodialysis patients found an average of 4.3 medication-related problems in each patient [4]. The most commonly identified medication-related problems in this analysis were inappropriate laboratory monitoring for drug therapy (23.5% of medication-related problems) and incorrect doses of prescribed medications (subtherapeu-tic dosage 11.2% and overdosage 9.2% of medication-related problems) [4]. Clearly, knowledge of the pharmaco-kinetic changes in CKD is essential for prescribers and caregivers.

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