Analgesics Safe in Renal Failure

Analgesic use in renal failure

June 7, 2014 – 06:04 pm

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Traditionally serum creatinine has been used as a measure of renal function. This is inaccurate as patients may have a clinically significant deterioration in renal function while still having a serum creatinine within the normal reference range.(Lamb et al)

Glomerular filtration rate (GFR) is a preferable measure of renal function. There are two generally accepted methods of estimating GFR
1. Cockcroft + Gault equation
2. 4 variant modification of diet in renal disease equation (4vMDRD)
Both methods are inaccurate at extremes of age and body weight. Estimated GFR (eGFR) is now provided with biochemistry results and is based on the 4vMDRD calculation. It will not have been adjusted for body total surface area.

eGFR classification of renal impairment

Degree impairment Chronic Kidney Disease (CKD) stage GFR ml/min/1.73m2 Creatinine clearance ml/min
Normal renal function 1 >90 120
Mildly reduced renal function in presence of renal disease. In absence of renal disease eGFR>60 is considered normal 2 60-89 20-50
Moderately reduced renal function 3 30-59 10-20
Severely reduced renal function 4 15-29

Source: www.stelizabethhospice.org.uk

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