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";s:4:"text";s:4501:" Cheigh J, Use of antibacterial agents in renal failure. New York, N.Y.: McGraw-Hill, 2005:185–215.Chobanian AV, Nguyen TV, This can cause an acute decline in GFR of more than 15 percent from baseline with proportional elevations in serum creatinine within the first week of initiating therapy.A common practice is to discontinue ACE-inhibitor and ARB therapy when the serum creatinine level rises more than 30 percent or if the serum potassium level is 5.6 mEq per L (5.6 mmol per L) or higher.Hydrophilic beta blockers (e.g., atenolol [Tenormin], bisoprolol [Zebeta], nadolol [Corgard], acebutolol [Sectral]) are eliminated renally and dosing adjustments are needed in patients with chronic kidney failure.Drug dosing requirements for hypoglycemic agents in patients with chronic kidney disease are listed in Lack of data in patients with a serum creatinine level higher than 2 mg per dL (180 μmol per L); therefore, acarbose should be avoided in these patientsAvoid in patients with a glomerular filtration rate less than 50 mL per minute because of the increased risk of hypoglycemiaDosage adjustment not necessary in patients with renal impairment50 percent of the active metabolite is excreted via the kidney, creating a potential for severe hypoglycemia; not recommended when creatinine clearance is less than 50 mL per minute (0.83 mL per second)Avoid if serum creatinine level is higher than 1.5 mg per dL (130 μmol per L) in men or higher than 1.4 mg per dL (120 μmol per L) in women, and in patients older than 80years or with chronic heart failure; fixed-dose combination with metformin should be used carefully in renal impairment; metformin should be temporarily discontinued for 24 to 48 hours before use of iodinated contrast agents, not restarted for 48 hours afterward, and then restarted only when renal function has normalizedLack of data in patients with a serum creatinine level higher than 2 mg per dL (180 μmol per L); therefore, acarbose should be avoided in these patientsAvoid in patients with a glomerular filtration rate less than 50 mL per minute because of the increased risk of hypoglycemiaDosage adjustment not necessary in patients with renal impairment50 percent of the active metabolite is excreted via the kidney, creating a potential for severe hypoglycemia; not recommended when creatinine clearance is less than 50 mL per minute (0.83 mL per second)Avoid if serum creatinine level is higher than 1.5 mg per dL (130 μmol per L) in men or higher than 1.4 mg per dL (120 μmol per L) in women, and in patients older than 80years or with chronic heart failure; fixed-dose combination with metformin should be used carefully in renal impairment; metformin should be temporarily discontinued for 24 to 48 hours before use of iodinated contrast agents, not restarted for 48 hours afterward, and then restarted only when renal function has normalizedA Cochrane review showed that lactic acidosis did not occur in the more than 20,000 patients with type 2 diabetes studied (patients with standard contraindications to metformin were not included).Sulfonylureas (e.g., chlorpropamide [Diabinese], glyburide [Micronase]) should be avoided in patients with stages 3 to 5 chronic kidney disease.500 mg every 12 hours to 1,000 mg every 8 hours, depending on indication250 to 500 mg every 12 hours (Biaxin); 1 g daily (Biaxin XL)1 to 2 g ampicillin and 0.5 to 1 g sulbactam every 6 to 8 hoursCarbenicillin IV (not available in the United States)200 to 500 mg per kg per day, continuous infusion or in divided doses500 to 750 mg initial dose, then 250 to 750 mg every 24 to 48 hours500 mg initial dose, then 250 to 500 mg every 48 hoursEvery 12 hours (GFR > 30); every 18 hours (GFR 10 to 30)500 mg every 12 hours to 1,000 mg every 8 hours, depending on indication250 to 500 mg every 12 hours (Biaxin); 1 g daily (Biaxin XL)1 to 2 g ampicillin and 0.5 to 1 g sulbactam every 6 to 8 hoursCarbenicillin IV (not available in the United States)200 to 500 mg per kg per day, continuous infusion or in divided doses500 to 750 mg initial dose, then 250 to 750 mg every 24 to 48 hours500 mg initial dose, then 250 to 500 mg every 48 hoursEvery 12 hours (GFR > 30); every 18 hours (GFR 10 to 30)Excessive serum levels of injectable penicillin G or carbenicillin (not available in the United States) may be associated with neuromuscular toxicity, myoclonus, seizures, or coma.Aminoglycosides should be avoided in patients with chronic kidney disease when possible. 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