Renal: Suggested questions

Last updated: Saturday, April 16, 2022

These specific questions may not apply to every situation you come across, but they are a good starting point for solving clinical problems about prescribing in patients with renal impairment. They are in addition to our general questions to ask in any clinical situation.

The medicine

  • What is the indication for the drug? In case you have to offer safer alternatives. It also helps you to weigh up the potential benefit(s) of using the drug versus the potential risk(s).
  • Which agent would you prefer to use, and are there any alternatives you’d consider? This helps you focus on therapeutic alternatives that the prescriber thinks are most appropriate to the patient’s clinical condition or history.

The patient

  • Extent of renal impairment? Calculate the creatinine clearance where necessary, for which you’d need to ask about the age, weight and height of the patient and their serum creatinine.
  • Is this acute or chronic impairment? Or is it 'acute on chronic' – someone with pre-existing chronic renal failure, who has had a sudden drop in function? An acute impairment might require ongoing monitoring and revision of the dose when the impairment starts to improve.
  • Is renal function stable? Or is it deteriorating, improving, or fluctuating? This determines whether a dose adjustment that you recommend might need to be revised regularly as renal function changes. A medicine that is largely cleared by non-renal routes is preferable in this situation if possible.
  • Which, if any, renal replacement therapy is being used? You need to tailor your dose recommendation to the individual patient’s circumstances. Ask about the timing of any intermittent peritoneal dialysis or haemodialysis because doses may need to be given post-dialysis.

Going forward

  • Who needs to know? Who can change therapy or dose if necessary? Is the patient under a specialist renal team? Will the patient and their GP be informed if dose adjustments will affect care after leaving hospital?
  • Who will be monitoring the patient? If renal function changes, it may affect side effects or efficacy.  

The 'questions to ask' from every tutorial on this site have been brought together into a Quick Question Guide that you may want to download for future reference.