Abstract

 Chronic Kidney Disease (CKD) significantly alters drug metabolism, necessitating adjustments in prescribing practices to ensure safe and effective therapy. CKD affects the pharmacokinetics of many drugs by impairing renal excretion and altering non-renal pathways, such as hepatic metabolism and gut microbiota interactions. These changes can lead to drug accumulation and increased risk of toxicity. Moreover, CKD-related modifications in protein binding and transporter activity further complicate drug disposition. Clinicians must consider these pharmacokinetic alterations and the disease’s progression when selecting and dosing medications. This review highlights the impact of CKD on drug metabolism and provides guidance for optimizing pharmacotherapy in affected patients, emphasizing the need for personalized medicine approaches in this population.