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 and those on dialysis.

Essential Questions and References

How should 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. 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
  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. 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]
  5. Scherer JS, Combs SA, Brennan F. Sleep Disorders, Restless Legs Syndrome, and Uremic Pruritus: Diagnosis and Treatment of Common Symptoms in Dialysis Patients. Am J Kidney Dis. 2017;69(1):117-128. [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. 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]
  8. Chen L, Greenberg WM, Brand-Schieber E, et al. Effect of renal impairment on the pharmacokinetics of levomilnacipran following a single oral dose of levomilnacipran extended-release capsule in humans. Drug Des Devel Ther. 2015;9:3293-300. [PubMed]
  9. 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]

In particular, should depression be managed differently in patients with renal disease?

  1. 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]
  2. 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]
  3. 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]
  4. 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]
  5. 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]
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