renbase – drug dosing in renal failure

Renal failure is an important, but often neglected, factor determining drug dosage in the elderly and patients with kidney disease. renbase decision support database includes a concise, up-to-date information on the safety and detailed dosage recommendations of different drugs and other substances, such as vitamins and micronutrients in patients with renal failure. All information has been produced according to standard operation procedures including both published medical information and the manufacturer provided information approved by EMA and FDA. All texts are produced and approved by medical doctors specialised in clinical pharmacology and therapeutics.

renbase analyses the pharmacokinetics and safety of various drugs and substances by dividing them into 4 categories based on the degree of renal failure (mild, moderate, severe, end-stage renal failure), according to the classification by the European Medicines Agency (EMA; see classification below). The information in renbase is divided into four parts. The DOSAGE RECOMMENDATION is divided into four categories, using a colour coding (see classification) and the user is always provided with an evidence based recommendation for dosage modification.  A free text part, ADDITIONAL INFORMATION provides the user with a detailed, in some cases indication-specific, information on what is known on the pharmacokinetics and use of each drug  during renal failure and with various methods of dialysis as well as recommendations for clinical and laboratory monitoring when prescribing/dispensing a specific agent. In renbase, the potential for NEPHROTOXICITY of each drug has been evaluated, which makes possible a listing and printing out such lists for patients. The REFERENCES are PubMed-linked to enable a quick access to the original publications.

renbase is updated four times a year. Copyright and the trademark of renbase belong to Medbase Ltd in Turku, Finland. 

Classification

In renbase, the degree of renal failure, based on glomerular filtration rate (GFR), is divided into four categories, according to the classification by the European Medicines Agency (EMA):

  1. GFR 90-60 ml/min (mild renal failure)
  2. GFR 30-30 ml/min (moderate renal failure)
  3. GFR 30-15 ml/min (severe renal failure)
  4. GFR <15 ml/min (end-stage renal failure; dialysis patient)

In renbase, the safety and need for dosage recommendations is classified into four different categories (A to D), clarified by a colour coding system:

A
 
No need for dosage modification
B
 
The information is not available or the recommendation is estimated based on the pharmacokinetic characteristics of the substance
C
 
Modification of the dose or dosage interval is needed
D
 
The use should be avoided

For categories B and C, detailed numerical information on the magnitude of dosage modification is provided whenever available.