Renal function reduction rises difficulties in dealing with many drugs. These problems are mainly due to the need of decreasing progressively the doses of the drugs that are cleared by the kidneys, in parallel with the progressive reduction in renal function. The degree of renal impairment should be better measured as the estimated glomerular filtration rate, avoiding to simply rely on plasma creatinine. Physicians should also be aware of the important potential side effects of some very effective and safe drugs, when they are used in patients with relevant reduction in renal function, independently of their possible plasma accumulation. As paradigmatic, we will discuss here the case of azathioprine, metformin and denosumab use, when renal function is heavily decreased.
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