Widespread availability to care for patients with renal diseases has notably increased the number and types of patients presenting to physicians for long term management. The patients with reduced renal function commonly require drug therapy for various associated conditions. On an average patients with kidney insufficiency are taking at least 7 different medications to manage not only the underlying disease (for example, diabetes) but also symptoms related to renal diseases. The frequency of adverse reactions increases with number of medications, degree of renal insufficiency, age of patient and other associated medical conditions. We present an article giving an overview of safe prescription in renal diseases.

Most drugs are partially or fully excreted by the kidneys; therefore, drugs dosage regimens often need to be adjusted in order to provide safe, yet effective treatment for patients with kidney diseases. In addition certain therapeutic agents are potential nephrotoxic and their pharmacologic actions that may jeopardize already compromised kidney function.

Although kidney impairment has its most important effect upon excretion, but other aspects of pharmacokinetics such as absorption, distribution (including protein binding), metabolism and kidney haemodynamics may be affected.

The following are the basic pharmacokinetic changes, which have important bearing in drug prescribing in renal insufficiency.

Effect of renal insufficiency on drug pharmacokinetics,