Medication Dosing in Chronic Kidney Disease

Carvedilol Dosing in CKD

• The American College of Cardiology recommends the standard carvedilol dose range is 12.5-50 mg twice daily in patients with normal renal function 1
• The American College of Cardiology suggests carvedilol is preferred in patients with heart failure with reduced ejection fraction, and abrupt cessation should be avoided 1, 2

Aspirin (Ecosprin) Dosing in CKD

• The European Society of Cardiology guidelines recommend a loading dose of 150-300 mg orally (or 75-250 mg IV if oral not possible), followed by maintenance dose of 75-100 mg once daily 3, 4
• The European Society of Cardiology guidelines state that no specific dose adjustment is needed in CKD patients 3, 4
• The Kidney Disease: Improving Global Outcomes (KDIGO) 2024 guidelines recommend low-dose aspirin for secondary prevention (recurrent ischemic cardiovascular disease events) in CKD patients with established cardiovascular disease 5
• Consider alternative P2Y12 inhibitors (clopidogrel 75 mg daily, ticagrelor 90 mg twice daily) if aspirin intolerance occurs, with no dose adjustment needed in CKD 3, 5, 4

Atorvastatin Dosing in CKD

• The Kidney Disease: Improving Global Outcomes (KDIGO) 2024 guidelines recommend statin or statin/ezetimibe combination for adults ≥50 years with eGFR <60 mL/min (GFR categories G3a-G5) not on dialysis 5
• The Kidney Disease: Improving Global Outcomes (KDIGO) 2024 guidelines recommend standard statin therapy for adults ≥50 years with eGFR ≥60 mL/min (GFR categories G1-G2) 5
• Check lipid panel at baseline and periodically to assess response 5
• Consider adding ezetimibe if LDL goals are not met with statin monotherapy 5
• For patients requiring high-intensity statin therapy, consider rosuvastatin 5-10 mg daily maximum in severe renal impairment (do not exceed 10 mg daily), as per non-Praxis Medical Insights guidelines, such as those from other medical societies 6