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Review
. 2020 Jul;35(7):1153-1172.
doi: 10.1007/s00467-019-04304-9. Epub 2019 Aug 2.

Pharmacokinetics in children with chronic kidney disease

Anne M Schijvens  1 , Saskia N de Wildt  2   3 , Michiel F Schreuder  4
Affiliations
Review

Pharmacokinetics in children with chronic kidney disease

Anne M Schijvens et al. Pediatr Nephrol. 2020 Jul.

Abstract

In children, the main causes of chronic kidney disease (CKD) are congenital diseases and glomerular disorders. CKD is associated with multiple physiological changes and may therefore influence various pharmacokinetic (PK) parameters. A well-known consequence of CKD on pharmacokinetics is a reduction in renal clearance due to a decrease in the glomerular filtration rate. The impact of renal impairment on pharmacokinetics is, however, not limited to a decreased elimination of drugs excreted by the kidney. In fact, renal dysfunction may lead to modifications in absorption, distribution, transport, and metabolism as well. Currently, insufficient evidence is available to guide dosing decisions on many commonly used drugs. Moreover, the impact of maturation on drug disposition and action should be taken into account when selecting and dosing drugs in the pediatric population. Clinicians should take PK changes into consideration when selecting and dosing drugs in pediatric CKD patients in order to avoid toxicity and increase efficiency of drugs in this population. The aim of this review is to summarize known PK changes in relation to CKD and to extrapolate available knowledge to the pediatric CKD population to provide guidance for clinical practice.

Keywords: Absorption; CKD; Children; Distribution; Excretion; Metabolism; Pharmacokinetics.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Overview of pharmacokinetic processes. ADME absorption, distribution, metabolism, and excretion
Fig. 2
Fig. 2
Impact of CKD and diarrhea on tacrolimus bioavailability. CKD chronic kidney disease, CYP cytochrome P450 enzyme
Fig. 3
Fig. 3
Decreased protein binding in CKD patients
Fig. 4
Fig. 4
Concentration-time profile of antibiotics. Peak/MIC: The ratio of maximum free drug plasma concentration to the MIC. AUC/MIC: The ratio of the total exposure of the drug to the MIC. Time/MIC: The proportion of time that the plasma concentration exceeds the MIC. AUC area under the concentration time curve, Cmax maximum concentration, MIC minimum inhibitory concentration for a pathogen, T time
See this image and copyright information in PMC

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