NEFROCALC 2.0
Drugs Dosing in Renal Failure (RF)
by Giusti-Hayton-Tozer's Formula,
for Adult Patients.

It is advisable to compare the adjusted doses through GHT formula, with the values suggested in the bibliography below, as well as to see the 37 recommendations of citation 8.


=Use dot to separate decimals=

Drugs
Click on a name to choose
Adjustment Factor (AF)
Enter the Creatinine Clearance (CLcr)
or GFR*
CLcr/GFR ml/min
  
AF

Method D
Normal Dose
  
Dose for RF

Method I
Normal Interval
  
Interval for RF

Method D/I
Normal Dose
Normal Interval
Desired Interval
  
Dose/Int. for RF

AF = Adjustment Factor.
Method D = Dosage reduction, normal interval.
Method I = Interval extension, normal dose.
Method D/I = Combination of both.
Dose for RF = mg, g or I.U.
Interval for RF = hours or days.

Post-dialysis replacement:
[HDs] Post-HD (standard filter).
[HDhp] Post-HD (high permeability filter).
[HD] Post-HD (HDs and HDhp).
[PD] Post-Peritoneal Dialysis.

Special care:
[a] No data on adjustment for RF.
[b] Avoid when CLcr 10ml/min.
[c] No data on adjustment for CLcr 10ml/min.
[d]
Avoid when CLcr 30ml/min.
[e] No data on adjustment for CLcr 30ml/min.
[f] Avoid when CLcr50ml/min.
[g] No data on adjustment for CLcr 50ml/min.
[h] Avoid when CLcr < 90ml/min.
[i] Active metabolites.
[j] Toxic metabolites.
[k] Use with extreme care.
[l] Attention to neurotoxicity.
[m] Attention to cardiotoxicity.
[n] Attention to nephrotoxicity.
[o] Warning for toxicity to the stomach.
[p] Attention to hepatotoxicity.
[q] Attention to myelotoxicity.
[r] Attention to rhabdomyolysis, myopathy.
[s] Can cause Nephrogenic Systemic Fibrosis.

Giusti-Hayton-Tozer's Formula
AF=1/[fe(FGpat/120-1)+1]
AF = Adjustment factor.
fe = the larger fraction of active substances (drugs or metabolites) excreted by the kidneys in normal conditions.
GFpat = Patient's Creatinine Clearance (or GFR) (ml/min).
120 = Normal Creatinine Clearance (or GFR) (ml/min).

*To calculate the AF use the CLcr or the GFR without standardization for 1.73m2 of body surface area. The calculators below reverses the CLcr or GFR to the unstandardized (unst.) value (unst. CLcr or GFR):


Body Surface Area (BSA)
Weight kg
Height cm
  
BSA m2

Creatinine Clearance (CLcr) or
Glomerular Filtration Rate (GFR)

=From standardized to unstandardized (unst.) value=
Clcr/GFR ml/min/1.73m2
BSA m2
  
unst. CLcr/GFR ml/min

=o=

New or missing substances
in the above drop-down list box

=Use dot to separate decimals=

Adjustment Factor (AF)
Enter the Creatinine Clearance (CLcr)
or GFR and fe**
CLcr/GFR ml/min
fe
  
AF

**fe = the larger fraction of active substances (drugs or metabolites) excreted by the kidneys in normal conditions.


Method D
Normal Dose
  
Dose for RF

Method I
Normal Interval
  
Interval for RF

Method D/I
Normal Dose
Normal Interval
Desired Interval
  
Dose/Int. for RF


BIBLIOGRAPHY

1. Aronoff GR, Bennett WM, Berns JS, Brier ME, Kasbekar N, Mueller BA, et al. Drug prescribing in renal failure: dosing guidelines for adults and children. 5th Ed. Philadelphia (PA): American College of Physicians; 2007.

2. Ashley C, Currie A.: The renal drug handbook. 4th ed. Oxford (UK): Radcliffe Medical Press; 2014.

3. Seyffart G. Seyffart's Directory of Drug Dosage in Kidney Disease. Dustri-Verlag Dr. Karl Feistle GmbH&Co. KG, Munich, 2011.

4. Cervelli MJ. The Renal Drug Reference Guide. Edited by Matthew J Cervelli, Adelaide, Australia; 2008.

5. Barsanulfo-Pereira E. Uso de Medicamentos na Insuficiência Renal. In Riella MC: Princípios de Nefrologia e Distúrbios Hidroeletrolíticos 5ª Ed., Cap. 50;902-938. Editora Guanabara-Koogan, Rio de Janeiro; 2010.

6. Golightly LK, Teitelbaum I, Kiser TH, Levin DA, Barber GR, Jones MA, Stolpman NM, Lundin KS. Renal Pharmacotherapy - Dosage Adjustment of Medications Eliminated by the Kidneys. Springer, NY, 2013.

7. Schrier RW, Gambertoglio JG.: Handbook of Drug Therapy in Liver and Kidney Disease. Little, Brown and Company, Boston, 1991.

8. Matzke GR, Aronoff GR, Atkinson Jr AJ, Bennett WM, Decker BS, Eckardt K-U, Golper T, Grabe DW, Kasiske B, Keller F, Kielstein JT, Mehta R, Mueller BA, Pasko DA, Schaefer F, Sica DA, Inker LA, Umans JG and Murray P. Drug dosing consideration in patients with acute and chronic kidney disease - a clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney International (2011) 80, 1122-1137.