2. CHRONIC KIDNEY DISEASE (CKD)

• Chronic kidney disease (CKD) affects more than 50 million people, with over 1 million receiving kidney replacement therapy
• The kidney regulates body fluids, electrolyte balance, removal of metabolic waste, and drug excretion from the body
• Impairment or degeneration of kidney function affects the pharmacokinetics of drugs
• Common causes of kidney failure include disease, injury, and drug intoxication
• Changes in renal dysfunction can disturb electrolyte and fluid balance, alter the pharmacokinetics and pharmacodynamics of a drug, and affect processes like drug distribution and elimination
• In uremic patients, changes in pharmacokinetics include alterations in bioavailability, volume of distribution, and clearance
• Renal impairment can lead to a decrease in drug-protein binding, resulting in a larger fraction of free drug and an increase in the volume of distribution
• Total body clearance of drugs in uremic patients is reduced by factors like decreased glomerular filtration rate (GFR), decreased tubular secretion, and reduced hepatic clearance
• Estimation of the appropriate drug dosage regimen in patients with impaired renal function is based on the remaining renal function of the patient and prediction of the total body clearance
• For IV infusions, the same desired steady-state concentration is maintained for patients with normal renal function and for patients with renal impairment
• Dose adjustment in renal disease considers pharmacokinetic changes resulting from the uremic condition, such as prolonged elimination half-lives and changes in volume of distribution
• Dose adjustment based on changes in the elimination rate constant may involve reducing the normal dose of the drug and keeping the frequency of dosing constant, or decreasing the frequency of dosing and keeping the dose constant
• Attachment is a strong reciprocal emotional bond between an infant and a primary caregiver

  
• Schaffer and Emerson's 1964 study on attachment:

  • Aim: identify stages of attachment / find a pattern in the development of an attachment between infants and parents
  • Participants: 60 babies from Glasgow
  • Procedure: analysed interactions between infants and carers
  • Findings: babies of parents/carers with 'sensitive responsiveness' were more likely to have formed an attachment
• Freud's superego is the moral component of the psyche, representing internalized societal values and standards
• The dosing of drugs in patients with renal impairment involves calculating the correct dose using an equation

  
• Creatinine is an endogenous substance formed from creatine phosphate during muscle metabolism
• Creatinine clearance from the serum creatinine concentration is a rapid and convenient way to monitor kidney function
• Blood urea nitrogen (BUN) levels indicate renal function, with higher levels suggesting renal disease
• In dosing uremic patients, the maintenance dose is based on the drug clearance in the patient, which is decreased in uremic patients
• The method of Welling and Craig (1976) provides an estimate of the ratio of the uremic elimination rate constant to the normal elimination rate constant based on creatinine clearance