Learning Objectives

  • Calculate and classify CKD stages using eGFR
  • Identify high-risk drug classes in renal impairment
  • Apply dose adjustments for common drugs
  • Know when to seek nephrology advice

eGFR and CKD Classification

CKD is classified by eGFR (ml/min/1.73m2):

  • G3a: 45-59 | G3b: 30-44 | G4: 15-29 | G5: <15

High-Risk Drug Classes

  • NSAIDs — avoid in CKD G3b+ (acute-on-chronic impairment, fluid retention)
  • Metformin — withhold when eGFR <30; reduce dose <45
  • Direct oral anticoagulants — dose-adjust based on specific drug and eGFR
  • ACE inhibitors/ARBs — continue but monitor K+ and creatinine; acceptable rise 30%

Monitoring

In CKD G3+:

  • Check U&E, eGFR every 6-12 months (G3) or 3-6 months (G4-5)
  • Annual urine ACR
  • Blood pressure target <140/90 (<130/80 if proteinuria)

Key Resources

  • BNF — dose adjustments listed per drug
  • Renal Drug Database (renaldrugdatabase.com)
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