 |
 |
 |
           |
 |
 |
 |
|
 |
 |
|
|
|
 |
Your Kidney Function Really Matters: A Lighter Look at What You Need to Know to Prevent Adverse Dru
When you (or loved ones) are taking prescription or over the counter medications...there is a lot you should be worried about, and a lot that your pharmacist may not be telling you. Most people are aware, for example, that several medications taken together can sometimes cause harmful interactions. Most also know that drug allergies can pose significant hazards. (These are topics of other articles in this series). And, many people know that young children, elderly adults, pregnant women, nursing women, and severely debilitated people may all be at higher risk for adverse drug events. But what most people don't know is that a simple blood test can be one of the most important pieces of information in determining the correct dose of many medications...and the results of that test are almost never available to your pharmacist, especially if your pharmacist fills your prescription in a retail drugstore. (And, that's a bummer.) The test I'm talking about, of course, is the 'serum creatinine test' ('SEAR-'em cree-AT-tuh-neen tehst'. It's a difficult name to pronounce and a difficult test to understand...but one that you NEED to know about if you or loved ones are taking over-the-counter or prescription medications.) A serum creatinine test gives a physician or pharmacist an estimate of kidney function. Serum creatinine is the 'bean counter' of modern medicine... letting folks know if the beans (the kidneys) are working as well as they should. Why is that important? Well, kidney function is extremely important in determining the correct doses of many medications since the kidneys (along with the liver) assist in the removal of medications from the body. Almost all medications (and/or their chemical by-products) are either removed by the liver, by the kidneys, or, in many cases, by both the kidneys and liver working together. So, simply put, when the beans are not working well, many medications will accumulate in the body and increase the risk of drug side effects. And that's an even bigger bummer. (The same is true for liver problems, and we will talk about that in another article in this series.) As a result, patients with reduced kidney function often need LOWER doses of many medications. So how does this all work? Well, creatinine is a chemical that occurs and circulates naturally in the human body. It is the result of normal protein break-down. And, like many medications, creatinine is normally removed from the blood by the beans. So, when the kidneys are not working well, the level of creatinine circulating in the bloodstream will start to go up...just like the blood level of many medications. Physicians and pharmacists are routinely and easily able to determine how much creatinine is in the blood with the results of a serum creatinine test. (This test is part of a very common panel of blood tests. And, if the serum creatinine is high, many drugs need to have a lower dose.) The normal value for serum creatinine is about 0.4 to 1.5 mg/dl...but that can vary a bit from lab to lab. So remember: 'kidneys no work...serum creatinine go UP'. Now, serum creatinine is not the best measure of kidney function (there are other tests that are much more accurate), but results of the serum creatinine test are usually the most readily available...and cheapest...and are generally accurate enough for most purposes...so serum creatinine is the de facto standard for estimating kidney function...most of the time. The gold standard test that doctors use for measuring kidney function is called 'creatinine clearance' (cree-AT-tuh-neeeen CLEAR-uhhh-nce) However, not many patients get this particular test because it is pretty darn inconvenient...and smelly. You have to collect all of your urine for 24 hours and keep it in the fridge. Not a lot of volunteers for this test... Creatinine clearance is the volume of blood that the kidneys clear of creatinine in a given amount of time (and it is usually reported as milliliters per minute). So, when kidney function decreases, creatinine clearance (the amount of blood that the kidneys are successfully 'cleaning') also decreases. So remember: 'kidneys no work...creatinine clearance go DOWN'. (Note: this is easy to remember because it is the exact opposite of what you were initially thinking, and the opposite of what happens with serum creatinine. Most of medicine is like this.) Now for the super tricky part just for those gunning for an A. There is a way to 'guestimate' creatinine clearance using serum creatinine...isn't that neat. And, that's probably the best way to determine renal function if a measured creatinine clearance is not available. What you do is run the serum creatinine value through a fancy equation that will give you an estimated creatinine clearance, which is itself an estimate of kidney function. (Estimates of estimates of estimates...that's the kind of exacting science I live for.) For adults, that equation is the famous 'Cockcroft-Gault equation corrected for ideal body weight and gender'...the equation everyone loves to hate. The Cockcroft-Gault equation (presumably named after Drs. Cockcroft and Gault...or maybe just Dr. Cockroft-Gault, or maybe Lara Croft), is generally considered very reliable since it has never been well validated in young patients, old patients, thin patients, fat patients...basically all the patients it gets used on. So go figure. Double bonus points if you can remember this: For men, creatinine clearance = ((140- Age) ' IBW) / (72 ' SCr) For women, creatinine clearance = ((140- Age) ' IBW ' 0.85) / (72 ' SCr) Where Age is in years, IBW is ideal body weight in kilograms, and SCr is serum creatinine in mg/dl. (For the algebraically-challenged and for anyone wanting help in calculating the results of these complicated equations, please visit this creatinine clearance calculator: http://www.medicationadvisor.com/creatinine/creatinine.asp) Now once you run this a few times, you'll find that creatinine clearance for young healthy people is about 100 ml/min (we'll just leave off the 'ml/min' part from now on). And, dead people have a creatinine clearance of about 0, depending on how healthy they are. Everyone else falls somewhere in between. (Now someone in the back of the room is saying, 'I just ran this on myself and I have a creatinine clearance of 150'. Well aren't you special? In fact, young good-looking people can have creatinine clearances of 130, 140, or more...but it doesn't do a whole lot of good since 100 is perfectly acceptable. In fact, it's just another case of overachiever overkill.) Now, if someone has a creatinine clearance of 80, that means that they have about...80% kidney function. And, if someone has a creatinine clearance of 50, that means that they have about...50% kidney function. (Are you following all of this?) Many drugs that are eliminated by the kidney will require moderate dosage reductions once a patient's renal function is in the 40-60 range. Patients in the 20-40 range will typically require very large reductions in dose. And, patients who are in the 'less than 20' range will often need HUGE dosage reductions for medications eliminated by the kidney (or better yet, they'll need to take medications that are removed by some other organ altogether...if such an alternative is available). One last tidbit to consider. Renal function declines as people age. No getting around that. But, the rate of decline is different for different people. By the time you're 50 years old, there is a reasonable chance you'll have moderate renal function (or worse)...by the time you're 80, you'll almost certainly have some important degree of renal impairment... and you probably won't even know it or feel it. Now that you know more renal physiology than you ever, EVER wanted to know...let's get back to the main thread of this article...medication safety. If you (or a loved one) are at risk for having decreased kidney function (and I'll tell you who such folks are in just a second), you need to step up to the plate and get a handle on this issue (because there is a very good chance that your physician and pharmacist either didn't have renal function data or didn't consider it when coming up with a dosage for you). Here are the steps I recommend for everyone taking prescription or over-the-counter medications: 1) For everyone: If you have access to the results of a recent serum creatinine test (it is probably part of your annual physical and you may have gotten a copy), memorize it or write it down and then say to your physician or pharmacist when you get a medication, 'Say, I think my serum creatinine is about X. So, does this medication need any dosage adjustment in order to be safe for me? 2) If you are in one of the following categories, you should expect your physician and pharmacist to have considered your renal function before dosing a medication:
So you might say to your physician or pharmacist, 'Is this drug removed by the kidney, because I have condition X that could decrease kidney function and I just want to be safe.' If the drug is removed by the kidney, you might also ask the physician or pharmacist to tell you what your serum creatinine is...and if he or she does not have this information, a big red flag should be going up in your head. 3) If you are not in one of the categories in question 2 and you don't have a serum creatinine available, don't worry. You're probably safe. But you may want to ask your physician if there is a serum creatinine in your chart and if so, what it is. 4) If you are on dialysis of any sort, serum creatinine is not all that useful for dosing medications. Just make sure your physician and pharmacist are aware that you are on dialysis and perhaps ask, 'Now is this the usual dose for someone on dialysis?' These are some of the steps I hope you will consider the next time you get a prescription or over-the-counter medication so you can be sure that that you (or your loved one) are getting the right dose. © 2004 Timothy McNamara, MD, MPH About The Author Timothy McNamara, MD, MPH is a nationally prominent expert in medication safety and healthcare technology. For additional practical steps you can take to improve medication safety and a personalized report of your medication profile, go to: http://www.medicationadvisor.com/art2.asp
MORE RESOURCES:
Medicine - Google News |
|
|
|
RELATED ARTICLES
Irritable Bowel Syndrome - Cybill Shepherd Reveals All Cybill Shepherd has revealed that she suffers from irritable bowel syndrome (IBS). The star of Moonlighting and Taxi Driver says that she has struggled with her symptoms for many years, and is now hoping to raise awareness of IBS and encourage sufferers to talk more openly with their doctors. Traditional Treatments for Back Pain... Which Ones Work and Which Ones Don't? When Dorothy followed the yellow brick road, she was told to do so by those who wanted her to get where she wanted go. Well as humans when we blindly follow recommendations even by individuals who have good intentions, it may not always be your best option. Kids and Medication Part I We have all talked a lot about the problems in our educational system, about latchkey kids, about teacher turnover (50 percent of teachers quitted within the first five years on the job), psychologists over prescribing medications such as Prozac and Ritalin with our friends and families. We can all foresee a terrible problem in the future because we are feeding these drugs to kids under the age of six, their brains have not been fully formed yet and these drugs and their predecessors and competing drugs all have adverse side effects. Marketing Authorisation - Medicinal Products Marketing Authorisation: Medicinal Products The case of R (on the application of Merck Sharp and Dohme Ltd) v Licensing Authority [2005], concerned the application for marketing authorisation for a generic product which was based on Product C (see below).The claimant had marketing authorisations for three medicinal products used in the treatment of osteoporosis and three generic companies sought marketing authorisation for Product C. A Closer Look at Neck Pain Relief Neck pain afflicts many people at some point in their life - two-thirds of American adults report having experienced at least one incidence of neck pain in their lives. You can strain your neck during exercise, at work, or even something as simple as turning over in your sleep. Cholesterol Treatments Options: Statins Satins are pharmacuetical drugs that work by restricting the enzyme HMG CoA reductase. This is an enzyme which regulates how fast a rate cholesterol is produced in the body. Common Drugs and Their Uses The five drugs that are discussed in this article are Ibuprofen which is a non-steroidal anti-inflammatory drug (NSAID) that is commonly used for relief of Arthritis, Warfarin which is an anticoagulant drug commonly prescribed by doctors to treat venous thrombosis, pulmonary embolism, to treat or prevent dangerous blood clotting in people with arterial fibrillation and to prevent strokes, a benzodiazepine drug called Diazepam which is commonly prescribed by doctors for relieve nervousness, anxiety, and anxiety disorders, a sulfonylureas drug called Glipizide which is used to help control blood sugar levels and used to treat type 2 diabetes and a thyroid medication called Armour Thyroid which is prescribed for the treatment of hypothyroidism.Arthritis is a common illness in today's society; doctors prescribe drugs called non-steroidal anti-inflammatory drugs (NSAIDs) for this condition. Bextra and Vioxx Withdrawal Spurs Price Increase Among Rivals The market for painkillers is huge. People don't like pain and inflammation, and last year Americans spent nearly $4 billion on just two of them - Vioxx and Bextra. Lunesta Personality Changes Lunesta is a newly released sleeping pill. Marketed as a revolutionary sleep aid, Lunesta is the only medication approved by the FDA for long term treatment of insomnia symptoms. Why Drug Companies are Naughty and 5 Remedies to Cure the Symptoms With the hum of the election campaign and the debate of "big business," versus human interest, I decided to do a bit of muckraking into the art and science of the recent removal of Merck's Vioxx. My motivation of course; to look for clues as to the role drug companies play in our health and wellness (or lack thereof). 4 Reasons to Feel Safe Submitting an Electronic Medical Claim Electronic Medical ClaimFor years, both practices and patients have had to deal with submitting medical claims. Up until recently, claims were submitted manually, using HCFA 1500 forms. The Top Seven Myths About Arthritis Myth #1: "Nothing can be done about arthritis.. Curing Lou Gehrigs Disease ALS is the disease that took the life of the famed baseball player. The disease benched Lou Gehrig from the game that he loved and later took his life. Lipitor Lawyer: Statin Drugs Cause Muscle Damage in 98% Doctors have been encouraged to prescribe the cholesterol-lowering drugs called statins quite liberally. Patients who suffer heart attacks often have elevated levels of cholesterol, so statins like Lipitor are prescribed to lower the cholesterol. Quitting Smoking: Planning To Succeed With Zyban! Step One: The Big DecisionOne of the most frustrating things about deciding to quit smoking can be people's reactions: "Well, it's about time!" or "It was a filthy habit, why didn't you quit sooner?" But as anyone who has been using nicotine knows, it's one of the hardest decisions, and one of the most difficult tasks, many people face. For many of us, smoking isn't just a physical addiction: we may associate smoking with our first cup of coffee in Paris or favorite college bar. Finally...Affordable Prescription Medication without Insurance. If you are like many Americans, you are without health insurance. And the ranks of the uninsured are growing. Why R.I.C.E.? What is R.I. Online Pharmacies and the FDA The FDA (Food and Drug Administration) is responsible for overseeing the testing, manufacturing, and distribution of prescription drugs in the United States.Drug companies in the United States operate in a free market and can charge whatever they want for their medications. 22 Inside Tips on How You Can Make Your Arthritis Medicines Work Twice as Effectively in Half the.. This report will give you 22 important tips to make sure that you're getting the very best out of your arthritis treatment program.1. Spin Control: What to Do When Youre Dizzy Dizzy Dean, the great baseball pitcher of the 1930s-1940s, once quipped, "The doctors x-rayed my head and found nothing."That is as good an analogy as any in describing what often happens to patients with the symptom of dizziness.
|
 |