Leah Foster Smith
Patients receiving dialysis are among the most medically complex populations in health care and are at high risk for medication-related problems. Polypharmacy, frequent hospitalizations, multiple comorbid conditions, and care from numerous health care providers contribute to medication discrepancies and adverse drug events. In addition, advanced kidney disease significantly alters drug absorption, distribution, metabolism, and elimination, requiring careful application of renal drug dosing principles. Nephrology nurses and advanced practice providers play critical roles in medication reconciliation, patient education, monitoring for adverse effects, and promoting medication safety. This article reviews dialysis pharmacokinetics, principles of renal drug dosing, common medication considerations in patients on dialysis, and practical strategies to optimize medication safety and therapeutic outcomes.