Letter

Dose adjustment in renal impairment: Response from Drug Prescribing in Renal Failure

BMJ 2005; 331 doi: 10.1136/bmj.331.7511.293-a (Published 28 July 2005)
Cite this as: BMJ 2005;331:293.2

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  1. George R Aronoff, professor of medicine and pharmacology (George.Aronoff@kdp.louisville.edu)
  1. University of Louisville Kidney Disease Program, 615 South Preston Street, Louisville, KY 40202, USA

    EDITOR—Vidal et al should be congratulated on the first scholarly, systematic review of secondary sources of prescribing information for patients with impaired renal function (p 263).1 That they found inconsistent and conflicting recommendations across multiple sources is not surprising. Their work underscores several problems with which we have struggled to compile our dosing recommendations in Drug Prescribing in Renal Failure.2

    Primary sources

    Early regulatory requirements did not include formal efficacy, safety, or pharmacokinetic studies for drugs in special populations, including patients with impaired kidney or liver function. Consequently, dosing recommendations for many older drugs are based on flimsy data, including sparse case reports, common usage, and …

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