Psychiatric Pharmacy Essentials: Psychotropic Medication and Dialysis

The prevalence of psychiatric disorders has been well documented in individuals with renal insufficiency. Although not robust, data exists to guide medication choices and dosing strategies in patients with renal insufficiency, including those on dialysis.

Essential Questions and References

How should psychotropic medications be dosed in patients with renal insufficiency or those on dialysis?

  1. Caballero J, Potter JL. Guide to Renal/Dialysis Considerations. JCPNP. 2002;1(1). [Weblink]
  2. Baghdady NT, Banik S, Swartz SA, McIntyre RS. Psychotropic drugs and renal failure: translating the evidence for clinical practice. Adv Ther. 2009;26(4):404-24. [PubMed]
  3. Eyler RF, Unruh ML, Quinn DK, Vilay AM. Psychotherapeutic Agents in End-Stage Renal Disease. Semin Dial. 2015;28(4):417-26. [PubMed]
  4. Ward S, Roberts JP, Resch WJ, Thomas C. When to adjust the dosing of psychotropics in patients with renal impairment. Current Psychiatry. 2016;15(8):60-66. [Weblink]
  5. Mathew RO, Bettinger JJ, Wegrzyn EL, Fudin J. Pharmacotherapeutic considerations for chronic pain in chronic kidney and end-stage renal disease. J Pain Res. 2016;9:1191-1195. [PubMed]
  6. Whittaker CF, Miklich MA, Patel RS, Fink JC. Medication Safety Principles and Practice in CKD. Clin J Am Soc Nephrol. 2018;13(11):1738-1746. [PubMed]
  7. Nemecek BD, Hammon DA. Demystifying Drug Dosing in Renal Dysfunction. 2019. American Society of Health-System Pharmacists. ISBN: 978-158528-551-8. [Weblink]
    • Requires purchase

How should depression be managed in patients with renal disease??

  1. Nagler EV, Webster AC, Vanholder R, Zoccali C. Antidepressants for depression in stage 3-5 chronic kidney disease: a systematic review of pharmacokinetics, efficacy and safety with recommendations by European Renal Best Practice (ERBP). Nephrol Dial Transplant. 2012; 27(10): 3736-45. [PubMed]
  2. Bautovich A, Katz I, Smith M, Loo CK, Harvey SB. Depression and chronic kidney disease: A review for clinicians. Aust N Z J Psychiatry. 2014;48(6):530-41. [PubMed]
  3. Shirazian S, Grant CD, Aina O, et al. Depression in Chronic Kidney Disease and End-Stage Renal Disease: Similarities and Differences in Diagnosis, Epidemiology, and Management. Kidney Int Rep. 2017;2(1):94-107. [PubMed]
  4. Hedayati SS, Gregg LP, Carmody T, et al. Effect of sertraline on depressive symptoms in patients with chronic kidney disease without dialysis dependence: the CAST randomized clinical trial. JAMA. 2017; 318(19):1876-90. [PubMed]
  5. Assimon MM, Brookhart MA, Flythe JE. Comparative Cardiac Safety of Selective Serotonin Reuptake Inhibitors among Individuals Receiving Maintenance Hemodialysis. J Am Soc Nephrol. 2019;30(4):611-623. [PubMed]
  6. Mehrotra R, Cukor D, Unruh M, et al. Comparative Efficacy of Therapies for Treatment of Depression for Patients Undergoing Maintenance Hemodialysis: A Randomized Clinical Trial. Ann Intern Med. 2019;170(6):369-379. [PubMed]
Reviewer 1: Allison Beatty, PharmD, BCCP
Reviewer 2: Mackenzie Pierce, PharmD, BCPS, BCPP
Reviewer 3: Joseph M. Cusimano, PharmD, BCPP
2022-2023 AAPP Resident and New Practitioner Committee