Displaying publications 1 - 20 of 51 in total

  1. Jalalonmuhali M, Elagel SMA, Tan MP, Lim SK, Ng KP
    Int J Nephrol, 2018;2018:3081518.
    PMID: 29862077 DOI: 10.1155/2018/3081518
    Background: To assess the performance of different GFR estimating equations, test the diagnostic value of serum cystatin-C, and compare the applicability of cystatin-C based equation with serum creatinine based equation for estimating GFR (eGFR) in comparison with measured GFR in the elderly Malaysian patients.

    Methods: A cross-sectional study recruiting volunteered patients 65 years and older attending medical outpatient clinic. 51 chromium EDTA (51Cr-EDTA) was used as measured GFR. The predictive capabilities of Cockcroft-Gault equation corrected for body surface area (CGBSA), four-variable Modification of Diet in Renal Disease (4-MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations using serum creatinine (CKD-EPIcr) as well as serum cystatin-C (CKD-EPIcys) were calculated.

    Results: A total of 40 patients, 77.5% male, with mean measured GFR 41.2 ± 18.9 ml/min/1.73 m2 were enrolled. Mean bias was the smallest for 4-MDRD; meanwhile, CKD-EPIcr had the highest precision and accuracy with lower limit of agreement among other equations. CKD-EPIcys equation did not show any improvement in GFR estimation in comparison to CKD-EPIcr and MDRD.

    Conclusion: The CKD-EPIcr formula appears to be more accurate and correlates better with measured GFR in this cohort of elderly patients.

    Study site: medical outpatient clinic. University of Malaya Medical Centre (UMMC)
    Matched MeSH terms: Glomerular Filtration Rate*
  2. Azrina Md Ralib, Farah Nadia Mohd Hanafiah, Fatimah Dzaharudin, Muhammad Rasydan Abd Ghani, Mohd Nizamudin Ismail, Mohd Basri Mat Nor
    Kinetic estimate of GFR (keGFR) is a more accurate estimate of GFR in the
    acute settings with rapidly changing kidney functions. It takes into account the changes
    of creatinine over time, creatinine production rate, and the volume of distribution,
    however needs serial measurement of creatinine. We evaluated which methods of the
    conventional eGFR measurement best correlates with keGFR. This could assist clinicians
    in using a simpler method of calculation and is useful in the absence of serial plasma
    creatinine. (Copied from article).
    Matched MeSH terms: Glomerular Filtration Rate
  3. Jalalonmuhali M, Kok Peng N, Soo Kun L
    Int J Nephrol, 2017;2017:2901581.
    PMID: 28702264 DOI: 10.1155/2017/2901581
    AIM: To validate the accuracy of estimated glomerular filtration rate (eGFR) equations in Malay population attending our hospital in comparison with radiolabeled measured GFR.
    METHODS: A cross-sectional study recruiting volunteered patients in the outpatient setting. Chromium EDTA (51Cr-EDTA) was used as measured GFR. The predictive capabilities of Cockcroft-Gault equation corrected for body surface area (CGBSA), four-variable Modification of Diet in Renal Disease (4-MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations were calculated.
    RESULTS: A total of 51 subjects were recruited with mean measured GFR 42.04 (17.70-111.10) ml/min/1.73 m(2). Estimated GFR based on CGBSA, 4-MDRD, and CKD-EPI were 40.47 (16.52-115.52), 35.90 (14.00-98.00), and 37.24 (14.00-121.00), respectively. Higher accuracy was noted in 4-MDRD equations throughout all GFR groups except for subgroup of GFR ≥ 60 ml/min/1.73 m(2) where CGBSA was better.
    CONCLUSIONS: The 4-MDRD equation seems to perform better in estimating GFR in Malay CKD patients generally and specifically in the subgroup of GFR < 60 ml/min/1.73 m(2) and both BMI subgroups.
    Study site: University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
    Matched MeSH terms: Glomerular Filtration Rate*
  4. Wong FN, Tan JA, Keng TC, Ng KP, Chua KH, Kuppusamy UR
    Clin. Chim. Acta, 2016 Jan 30;453:56-61.
    PMID: 26657980 DOI: 10.1016/j.cca.2015.12.002
    BACKGROUND: This study aimed to investigate the relationship between soluble RAGE and estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease (CKD) after controlling for the potential confounding factors such as medication usage and enzymatic antioxidants.
    METHODS: A total of 222 CKD patients whose eGFR is less than 60ml/min/1.73m(2) and 111 non-CKD individuals were recruited. The study subjects were classified based on their diabetes status. The plasma glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities as well as plasma soluble RAGE level were measured.
    RESULTS: The plasma GPx and SOD activities were significantly lower and the plasma soluble RAGE level was significantly higher in the CKD patients than in the non-CKD individuals, regardless of the diabetes status. Soluble RAGE was significantly correlated with eGFR in both diabetic CKD (D-CKD) and non-diabetic CKD (ND-CKD) patients. The association between soluble RAGE and eGFR remained largely unaffected by the confounding factors in D-CKD patients. However, the confounding effect of enzymatic antioxidants in the relationship between eGFR and soluble RAGE was observed in ND-CKD patients.
    CONCLUSION: The increased plasma level of soluble RAGE is a better indicator of renal function decline in diabetic CKD patients instead of non-diabetic CKD patients.
    KEYWORDS: Chronic kidney disease; Diabetes; Enzymatic antioxidants; Glomerular filtration rate; Medications; Soluble RAGE
    Matched MeSH terms: Glomerular Filtration Rate
  5. Azrina Md Ralib, Iqbalmunawwir Ab Rashid, Nur Aisyah Ishak, Suhaila Nanyan, Nur Fariza Ramly, Mohd Basri Mat Nor
    Plasma Cystatin C (CysC) is as an early functional marker for acute kidney
    injury. Estimates of glomerular filtration rate using CysC (eGFRCysC) has been used in
    some clinical setting. We evaluated the utility of CysC and eGFRCysC in diagnosing acute
    kidney injury (AKI) and predicting death in critically ill patients with sepsis. (Copied from article).
    Matched MeSH terms: Glomerular Filtration Rate
  6. Danial M, Hassali MA, Ong LM, Khan AH
    BMC Pharmacol Toxicol, 2018 Aug 29;19(1):52.
    PMID: 30157959 DOI: 10.1186/s40360-018-0243-0
    BACKGROUND: Accurate identification and routine preventive practices are crucial steps in lessening the incidence of medications and patients related adverse drug reactions (ADRs).

    METHODS: Three years retrospective study was conducted among chronic kidney disease (CKD) patients at multi-wards in a tertiary healthcare center. Data collected included demographic characteristics, physical examination results, comorbid conditions, laboratory tests and medications taken. Only medication prescribed during the hospital stay were considered in this study.

    RESULTS: From this study only one ADR incident was definitely preventable and majority of other ADRs (88.3%) were possibly preventable. Type of renal replacement therapy (p = 0.023) and stages of renal function (p = 0.002) were significantly associated with survivability of the hospitalized CKD patients after ADRs. Highest percentage of mortality based on categories were 50-59 years (20.0%), male (16.3%), Indian ethnicity (23.7%), obese (15.0%), smoking (17.1%), consumes alcohol (17.4%), conservative management of renal disease (19.5%) and renal function of rate between patients undergoing hemodialysis and patients conservatively managing their renal disease. The 18 days survival rate of patients undergoing hemodialysis, peritoneal dialysis and conservative management were 94.9%, 91.7% and 75.1% respectively. Eighteen days survival rate of patients with renal functions of 30-59 mL/min/1.73m2, 15-29 mL/min/1.73m2 and 
    Matched MeSH terms: Glomerular Filtration Rate
  7. Liao CM, Cheong IKS, Kong NCT
    Family Physician, 1991;3(2):31-33.
    Creatinine clearance is calculated from 24 hour urine creatinine excretion. This method of measuring creatinine clearance is cumbersome. Many formulae have been proposed as an alternative method of obtaining predicted creatinine clearance and they have all shown satisfactory results. From our study using 4 formulae, the correlation coefficient using these formulae rangedfrom 0.71 - 0.75. The correlation clearance was even better at > 0.90. We therefore advocate the routine use of these formulae for predicting creatinine clearance by clinicians.
    Study site: Nephrology clinic, Universiti Kebangsaan Malaysia unit at Hospital Kuala Lumpur, Malaysia
    Matched MeSH terms: Glomerular Filtration Rate
  8. Bidin MZ, Shah AM, Stanslas J, Seong CLT
    Clin. Chim. Acta, 2019 Aug;495:239-250.
    PMID: 31009602 DOI: 10.1016/j.cca.2019.04.069
    INTRODUCTION: Chronic kidney disease (CKD) is a silent disease. Most CKD patients are unaware of their condition during the early stages of the disease which poses a challenge for healthcare professionals to institute treatment or start prevention. The trouble with the diagnosis of CKD is that in most parts of the world, it is still diagnosed based on measurements of serum creatinine and corresponding calculations of eGFR. There are controversies with the current staging system, especially in the methodology to diagnose and prognosticate CKD.

    OBJECTIVE: The aim of this review is to examine studies that focused on the different types of samples which may serve as a good and promising biomarker for early diagnosis of CKD or to detect rapidly declining renal function among CKD patient.

    METHOD: The review of international literature was made on paper and electronic databases Nature, PubMed, Springer Link and Science Direct. The Scopus index was used to verify the scientific relevance of the papers. Publications were selected based on the inclusion and exclusion criteria.

    RESULT: 63 publications were found to be compatible with the study objectives. Several biomarkers of interest with different sample types were taken for comparison.

    CONCLUSION: Biomarkers from urine samples yield more significant outcome as compare to biomarkers from blood samples. But, validation and confirmation with a different type of study designed on a larger population is needed. More comparison studies on different types of samples are needed to further illuminate which biomarker is the better tool for the diagnosis and prognosis of CKD.

    Matched MeSH terms: Glomerular Filtration Rate
  9. Foon TS, Yook Chin C, Chinna K
    Asia Pac J Public Health, 2015 Mar;27(2):NP640-9.
    PMID: 23761589 DOI: 10.1177/1010539513490193
    This study examines the rate of decline of estimated glomerular filtration rate (eGFR) over a 10-year period and the associated risk factors in type 2 diabetes mellitus (T2DM) patients. Medical records of T2DM patients were randomly selected. The rate of fall in eGFR (simplified modification of diet in renal disease formula) was used as a measure of decline. Univariate and multivariate analysis were performed to determine the factors associated with decline of kidney function. A total of 504 patients were selected. Mean age was 57.8 ± 9 years; 65.3% were females. The mean decline rate of eGFR was 0.89 ± 2.16 mL/min/1.73 m(2)/y. Baseline proteinuria, glycosylated hemoglobin level, duration of T2DM, and Malay race were associated with faster decline in eGFR. The expected greater deterioration in kidney function in this cohort was not seen. Treatment of proteinuria and glycemia should be optimized early to retard the decline in kidney function in patients with T2DM.
    Matched MeSH terms: Glomerular Filtration Rate/physiology
  10. Marwyne MN, Loo CY, Halim AG, Norella K, Sulaiman T, Zaleha MI
    Med. J. Malaysia, 2011 Oct;66(4):313-7.
    PMID: 22299549 MyJurnal
    Obesity and overweight are strong independent risk factors for chronic kidney disease (CKD). Using serum creatinine-based estimated glomerular filtration rate (eGFR) equations in these subjects may be inaccurate. On the other hand, cystatin C-based eGFR equations may overestimate CKD prevalence as recent findings suggest an association of cystatin C with obesity. The objective of this study was to assess the accuracy of a cystatin C-based eGFR equation compared to two creatinine -based eGFR equations in overweight and obese subjects.
    Matched MeSH terms: Glomerular Filtration Rate*
  11. Thomas B, Matsushita K, Abate KH, Al-Aly Z, Ärnlöv J, Asayama K, et al.
    J. Am. Soc. Nephrol., 2017 Jul;28(7):2167-2179.
    PMID: 28408440 DOI: 10.1681/ASN.2016050562
    The burden of premature death and health loss from ESRD is well described. Less is known regarding the burden of cardiovascular disease attributable to reduced GFR. We estimated the prevalence of reduced GFR categories 3, 4, and 5 (not on RRT) for 188 countries at six time points from 1990 to 2013. Relative risks of cardiovascular outcomes by three categories of reduced GFR were calculated by pooled random effects meta-analysis. Results are presented as deaths for outcomes of cardiovascular disease and ESRD and as disability-adjusted life years for outcomes of cardiovascular disease, GFR categories 3, 4, and 5, and ESRD. In 2013, reduced GFR was associated with 4% of deaths worldwide, or 2.2 million deaths (95% uncertainty interval [95% UI], 2.0 to 2.4 million). More than half of these attributable deaths were cardiovascular deaths (1.2 million; 95% UI, 1.1 to 1.4 million), whereas 0.96 million (95% UI, 0.81 to 1.0 million) were ESRD-related deaths. Compared with metabolic risk factors, reduced GFR ranked below high systolic BP, high body mass index, and high fasting plasma glucose, and similarly with high total cholesterol as a risk factor for disability-adjusted life years in both developed and developing world regions. In conclusion, by 2013, cardiovascular deaths attributed to reduced GFR outnumbered ESRD deaths throughout the world. Studies are needed to evaluate the benefit of early detection of CKD and treatment to decrease these deaths.
    Matched MeSH terms: Glomerular Filtration Rate*
  12. Jaddi NS, Abdullah S
    PLoS ONE, 2019;14(1):e0208308.
    PMID: 30608936 DOI: 10.1371/journal.pone.0208308
    Optimization of an artificial neural network model through the use of optimization algorithms is the common method employed to search for an optimum solution for a broad variety of real-world problems. One such optimization algorithm is the kidney-inspired algorithm (KA) which has recently been proposed in the literature. The algorithm mimics the four processes performed by the kidneys: filtration, reabsorption, secretion, and excretion. However, a human with reduced kidney function needs to undergo additional treatment to improve kidney performance. In the medical field, the glomerular filtration rate (GFR) test is used to check the health of kidneys. The test estimates the amount of blood that passes through the glomeruli each minute. In this paper, we mimic this kidney function test and the GFR result is used to select a suitable step to add to the basic KA process. This novel imitation is designed for both minimization and maximization problems. In the proposed method, depends on GFR test result which is less than 15 or falls between 15 and 60 or is more than 60 a particular action is performed. These additional processes are applied as required with the aim of improving exploration of the search space and increasing the likelihood of the KA finding the optimum solution. The proposed method is tested on test functions and its results are compared with those of the basic KA. Its performance on benchmark classification and time series prediction problems is also examined and compared with that of other available methods in the literature. In addition, the proposed method is applied to a real-world water quality prediction problem. The statistical analysis of all these applications showed that the proposed method had a ability to improve the optimization outcome.
    Matched MeSH terms: Glomerular Filtration Rate
  13. Sabanayagam C, Lim SC, Wong TY, Lee J, Shankar A, Tai ES
    Nephrol. Dial. Transplant., 2010 Aug;25(8):2564-70.
    PMID: 20185856 DOI: 10.1093/ndt/gfq084
    There is substantial heterogeneity in literature regarding the epidemiology for chronic kidney disease (CKD) in different Asian populations. We aimed to assess the prevalence and risk factors of CKD in a multi-ethnic Asian population in Singapore.
    Matched MeSH terms: Glomerular Filtration Rate/physiology
  14. Teo BW, Koh YY, Toh QC, Li J, Sinha AK, Shuter B, et al.
    Singapore Med J, 2014 Dec;55(12):656-9.
    PMID: 25630321
    INTRODUCTION: Clinical practice guidelines recommend using creatinine-based equations to estimate glomerular filtration rates (GFRs). While these equations were formulated for Caucasian-American populations and have adjustment coefficients for African-American populations, they are not validated for other ethnicities. The Chronic Kidney Disease-Epidemiology Collaborative Group (CKD-EPI) recently developed a new equation that uses both creatinine and cystatin C. We aimed to assess the accuracy of this equation in estimating the GFRs of participants (healthy and with chronic kidney disease [CKD]) from a multiethnic Asian population.

    METHODS: Serum samples from the Asian Kidney Disease Study and the Singapore Kidney Function Study were used. GFR was measured using plasma clearance of 99mTc-DTPA. GFR was estimated using the CKD-EPI equations. The performance of GFR estimation equations were examined using median and interquartile range values, and the percentage difference from the measured GFR.

    RESULTS: The study comprised 335 participants (69.3% with CKD; 38.5% Chinese, 29.6% Malays, 23.6% Indians, 8.3% others), with a mean age of 53.5 ± 15.1 years. Mean standardised serum creatinine was 127 ± 86 μmol/L, while mean standardised serum cystatin C and mean measured GFR were 1.43 ± 0.74 mg/L and 67 ± 33 mL/min/1.73 m2, respectively. The creatinine-cystatin C CKD-EPI equation performed the best, with an estimated GFR of 67 ± 35 mL/min/1.73 m2.

    CONCLUSION: The new creatinine-cystatin C equation estimated GFR with little bias, and had increased precision and accuracy in our multiethnic Asian population. This two-biomarker equation may increase the accuracy of population studies on CKD, without the need to consider ethnicity.
    Matched MeSH terms: Glomerular Filtration Rate*
  15. Singh HJ
    Jpn. J. Physiol., 1995;45(2):327-36.
    PMID: 7563967
    Standard renal clearance techniques were used to compare the effects of intravenous infusions of L-arginine, D-lysine and glycine on urinary calcium excretion in the rat. A significant calciuric response was evident following the infusion of all three amino acids in all the animals. The maximal effect was evident in rats receiving L-arginine. The mechanism for the increased urinary calcium excretion in rats infused with L-arginine and D-lysine appeared more due to a decreased fractional reabsorption of this cation as no significant changes in the glomerular filtration rate (GFR) were evident in these two groups. The calciuria in rats receiving glycine appears due to increased filtered load secondary to the increased GFR, suggesting that the mechanism for calciuria evident following protein ingestion or amino acid infusion may vary and may be dependent upon the amino acid ingested or infused.
    Matched MeSH terms: Glomerular Filtration Rate/physiology
  16. Loo CS, Zaki M, Sulaiman AB, Sukanya AB, Voon YC, Kua SL
    Med. J. Malaysia, 1994 Mar;49(1):36-43.
    PMID: 8057988
    Functional renal reserve is a measure of the capacity of the kidney to increase the glomerular filtration in response to the stimulus of a protein meal or amino acid infusion. The aim of this study was to evaluate the usefulness of protein meal test to measure functional renal reserve in normal subjects and various groups of renal patients. One hundred and twenty five subjects from the Nephrology Clinic, Kuala Lumpur General Hospital were subjected to a protein loading test to measure their renal reserve. Each subject had to eat a 100 gram cooked chicken meat and timed 2 hours urine collections before and after the test meal were done to measure the creatinine clearances. The 62 healthy subjects showed a mean renal reserve (creatinine clearance after protein loading-baseline creatinine clearance) of 31.0 ml/min. The 31 subjects with various kidney diseases showed a mean renal reserve of 13.5 ml/min. The 19 renal transplant recipients showed renal reserve of 13.2 ml/min. The 12 nephrectomised donors showed renal reserve of 5.4ml/min. Renal reserve may be used to assess suitability of living related transplant donor for nephrectomy.

    Study site: Nephrology Clinic, Kuala Lumpur General Hospital
    Matched MeSH terms: Glomerular Filtration Rate/physiology
  17. Jalalonmuhali M, Lim SK, Md Shah MN, Ng KP
    BMC Nephrol, 2017 Dec 13;18(1):363.
    PMID: 29237422 DOI: 10.1186/s12882-017-0776-2
    BACKGROUND: Accurate measurement of renal function is important: however, radiolabelled gold standard measurement of GFR is highly expensive and can only be used on a very limited scale. We aim to compare the performance of Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equations in the multi-ethnic population attending University Malaya Medical Centre (UMMC).
    METHODS: This is a cross-sectional study recruiting patients, who attend UMMC Nephrology clinics on voluntary basis. 51-Chromium EDTA (51Cr-EDTA) plasma level was used to measure the reference GFR. The serum creatinine was determined by IDMS reference modified Jaffe kinetic assay (CrJaffe). The predictive capabilities of MDRD and CKD-EPI based equations were calculated. Data was analysed using SPSS version 20 and correlation, bias, precision and accuracy were determined.
    RESULTS: A total of 113 subjects with mean age of 58.12 ± 14.76 years and BMI of 25.99 ± 4.29 kg/m2 were recruited. The mean reference GFR was 66.98 ± 40.65 ml/min/1.73m2, while the estimated GFR based on MDRD and CKD-EPI formula were 62.17 ± 40.40, and 60.44 ± 34.59, respectively. Both MDRD and CKD-EPI were well-correlated with reference GFR (0.806 and 0.867 respectively) and statistically significant with p 
    Matched MeSH terms: Glomerular Filtration Rate*
  18. Adnan S, Ratnam S, Kumar S, Paterson D, Lipman J, Roberts J, et al.
    Anaesth Intensive Care, 2014 Nov;42(6):715-22.
    PMID: 25342403
    Augmented renal clearance (ARC) refers to increased solute elimination by the kidneys. ARC has considerable implications for altered drug concentrations. The aims of this study were to describe the prevalence of ARC in a select cohort of patients admitted to a Malaysian intensive care unit (ICU) and to compare measured and calculated creatinine clearances in this group. Patients with an expected ICU stay of <24 hours plus an admission serum creatinine concentration <120 µmol/l, were enrolled from May to July 2013. Twenty-four hour urinary collections and serum creatinine concentrations were used to measure creatinine clearance. A total of 49 patients were included, with a median age of 34 years. Most study participants were male and admitted after trauma. Thirty-nine percent were found to have ARC. These patients were more commonly admitted in emergency (P=0.03), although no other covariants were identified as predicting ARC, likely due to the inclusion criteria and the study being under-powered. Significant imprecision was demonstrated when comparing calculated Cockcroft-Gault creatinine clearance (Crcl) and measured Crcl. Bias was larger in ARC patients, with Cockcroft-Gault Crcl being significantly lower than measured Crcl (P <0.01) and demonstrating poor correlation (rs=-0.04). In conclusion, critically ill patients with 'normal' serum creatinine concentrations have varied Crcl. Many are at risk of ARC, which may necessitate individualised drug dosing. Furthermore, significant bias and imprecision between calculated and measured Crcl exists, suggesting clinicians should carefully consider which method they employ in assessing renal function.
    Matched MeSH terms: Glomerular Filtration Rate/physiology
  19. Tangren JS, Wan Md Adnan WAH, Powe CE, Ecker J, Bramham K, Hladunewich MA, et al.
    Hypertension, 2018 08;72(2):451-459.
    PMID: 29915020 DOI: 10.1161/HYPERTENSIONAHA.118.11161
    An episode of clinically recovered acute kidney injury (r-AKI) has been identified as a risk factor for future hypertension and cardiovascular disease. Our objective was to assess whether r-AKI was associated with future preeclampsia and other adverse pregnancy outcomes and to identify whether severity of AKI or time interval between AKI and pregnancy was associated with pregnancy complications. We conducted a retrospective cohort study of women who delivered infants between 1998 and 2016 at Massachusetts General Hospital. AKI was defined using the 2012 Kidney Disease Improving Global Outcomes laboratory criteria with subsequent clinical recovery (estimate glomerular filtration rate, >90 mL/min per 1.73 m2 before conception). AKI was further classified by severity (Kidney Disease Improving Global Outcomes stages 1-3) and time interval between AKI episode and the start of pregnancy. Women with r-AKI had an increased rate of preeclampsia compared with women without previous r-AKI (22% versus 9%; P<0.001). Infants of women with r-AKI were born earlier (gestational age, 38.2±3.0 versus 39.0±2.2 weeks; P<0.001) and were more likely to be small for gestational age (9% versus 5%; P=0.002). Increasing severity of r-AKI was associated with increased risk of preeclampsia for stages 2 and 3 AKI (adjusted odds ratio, 3.5; 95% confidence interval, 2.1-5.7 and adjusted odds ratio, 6.5; 95% confidence interval, 3.5-12.0, respectively), but not for stage 1 (adjusted odds ratio, 1.7; 95% confidence interval, 0.9-3.2). A history of AKI before pregnancy, despite apparent full recovery, was associated with increased risk of pregnancy complications. Severity and timing of the AKI episode modified the risk.
    Matched MeSH terms: Glomerular Filtration Rate/physiology
  20. Hassan Y, Al-Ramahi R, Abd Aziz N, Ghazali R
    Ann. Acad. Med. Singap., 2009 Dec;38(12):1095-103.
    PMID: 20052447
    One of the most important drug-related problems in patients with chronic kidney disease (CKD) is medication dosing errors. Many medications and their metabolites are eliminated through the kidney. Thus, adequate renal function is important to avoid toxicity. Patients with renal impairment often have alterations in their pharmacokinetic and pharmacodynamic parameters. The clearance of drugs eliminated primarily by renal filtration is decreased by renal disease. Therefore, special consideration should be taken when these drugs are prescribed to patients with impaired renal function. Despite the importance of dosage adjustment in patients with CKD, such adjustments are sometimes ignored. Physicians and pharmacists can work together to accomplish safe drug prescribing. This task can be complex and require a stepwise approach to ensure effectiveness, minimise further damage and prevent drug nephrotoxicity.
    Matched MeSH terms: Glomerular Filtration Rate
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