Anyone caring for patients with chronic kidney disease (CKD) is aware of the extent to which pharmacotherapy is involved in the lives of these patients. Recently, it was reported that hemodialysis patients in one large dialysis system were prescribed a median of 12 different medications at any given time point [1]. This number of medications per patient has not changed in over a decade [2]. As pharmacists who work with CKD patients, we find that drug-related issues are foremost on the minds of these patients. Often these issues extend beyond the medications prescribed by their caregivers and go to over-the-counter medications and alternative or complementary therapies that they are taking without the knowledge of their caregivers.

Substantial morbidity and mortality have been associated with 'medication misadventures' in American patients [3]. and it is likely that this is magnified in CKD patients. The concept of 'drug-related problems' has been put forward to characterize the myriad of issues that can occur with pharmacotherapy in patients with CKD [2]. A pooled analysis of published reports of medication use in hemodialysis patients found an average of 4.3 medication-related problems in each patient [4]. The most commonly identified medication-related problems in this analysis were inappropriate laboratory monitoring for drug therapy (23.5% of medication-related problems) and incorrect doses of prescribed medications (subtherapeu-tic dosage 11.2% and overdosage 9.2% of medication-related problems) [4]. Clearly, knowledge of the pharmaco-kinetic changes in CKD is essential for prescribers and caregivers.

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