Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  28 (2024)
Volume  27 (2023)
Volume  26 (2022)
Volume  25 (2021)
Volume  24 (2020)
Volume  23 (2019)
Volume  22 (2018)
Volume  21 (2017)
Volume  20 (2016)
Volume  19 (2015)
Volume  18 (2014)
Volume  17 (2013)
Volume  16 (2012)
Volume  15 (2011)
Volume  14 (2010)
Volume  13 (2009)
Volume  12 (2008)
Volume  11 (2007)
Volume  10 (2006)
Volume  9 (2005)
Volume  8 (2004)
Related articles

VOLUME 24 , ISSUE S3 ( April, 2020 ) > List of Articles

INVITED ARTICLE

Drug Dosing in Critically Ill Patients with Acute Kidney Injury and on Renal Replacement Therapy

Namrata S Rao

Keywords : Acute kidney injury, Critically ill, Drug dosing

Citation Information : Rao NS. Drug Dosing in Critically Ill Patients with Acute Kidney Injury and on Renal Replacement Therapy. Indian J Crit Care Med 2020; 24 (S3):129-134.

DOI: 10.5005/jp-journals-10071-23392

License: CC BY-NC 4.0

Published Online: 25-10-2015

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Acute kidney injury (AKI) complicates in around 40–50% of patients in intensive care units (ICUs), and this can account for up to 80% mortality, especially in those patients requiring renal replacement therapy (RRT). Appropriate drug dosing in such patients is a challenge to the intensivists due to various factors such as patient related (appropriate body weight, organ clearance, serum protein concentration), drug related [molecular weight (MW), protein binding, volume of distribution (Vd), hydrophilicity, or hydrophobicity], and RRT related (type, modality of solute removal, filter characteristics, dose, and duration). Therapeutic drug monitoring (TDM) of drugs can be a promising solution to this complex scenario to titrate a drug to its clinical response, but it is available only for a few drugs. In this review, we discussed drug dosing aspects of antimicrobials, sedatives, and antiepileptics in critically ill patients with AKI on RRT.

HTML PDF Share
  1. Negi S, Koreeda D, Kobayashi S, Iwashita Y, Shigematu T. Renal replacement therapy for acute kidney injury. Ren Replace Ther 2016;2(1):31. DOI: 10.1186/s41100-016-0043-1.
  2. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005;294(7):813. DOI: 10.1001/jama.294.7.813.
  3. Murugan R, Kellum JA. Acute kidney injury: What's the prognosis? Nat Rev Nephrol 2011;7(4):209–217. DOI: 10.1038/nrneph.2011.13.
  4. Libório AB, Leite TT, De Oliveira Neves FM, Teles F, De Melo Bezerra CT. AKI complications in critically ill patients: association with mortality rates and RRT. Clin J Am Soc Nephrol 2015;10(1):21–28. DOI: 10.2215/CJN.04750514.
  5. Blot SI, Pea F, Lipman J. The effect of pathophysiology on pharmacokinetics in the critically ill patient:concepts appraised by the example of antimicrobial agents. Adv Drug Deliv Rev 2014;77:3–11. DOI: 10.1016/j.addr.2014.07.006.
  6. Scoville BA, Mueller BA. Medication dosing in critically ill patients with acute kidney injury treated with renal replacement therapy. Am J Kidney Dis 2013;61(3):490–500. DOI: 10.1053/j.ajkd.2012.08.042.
  7. Pistolesi V, Morabito S, Di MF, Regolisti G, Cantarelli C, Fiaccadori E. A guide to understanding antimicrobial drug dosing in critically ill patients on renal replacement therapy. Antimicrob Agents Chemother 2019;63(8):e00583-19. DOI: 10.1128/AAC.00583-19.
  8. Cheng V, Abdul-Aziz M-H, Roberts JA, Shekar K. Optimising drug dosing in patients receiving extracorporeal membrane oxygenation. J Thorac Dis 2018;10(S5):S629–S641. DOI: 10.21037/jtd.2017.09.154.
  9. Varghese JM, Roberts JA, Lipman J. Antimicrobial pharmacokinetic and pharmacodynamic issues in the critically ill with severe sepsis and septic shock. Crit Care Clin 2011;27(1):19–34. DOI: 10.1016/j.ccc.2010.09.006.
  10. Zamoner W, de Freitas FM, Garms DSS, de Oliveira MG, Balbi AL, Ponce D. Pharmacokinetics and pharmacodynamics of antibiotics in critically ill acute kidney injury patients. Pharmacol Res Perspect 2016;4(6):e00280. DOI: 10.1002/prp2.280.
  11. Li J, Xie S, Ahmed S, Wang F, Gu Y, Zhang C, et al. Antimicrobial activity and resistance: influencing factors. Front Pharmacol 2017;8:364. DOI: 10.3389/fphar.2017.00364.
  12. Prestinaci F, Pezzotti P, Pantosti A. Antimicrobial resistance: a global multifaceted phenomenon. Pathog Glob Health 2015;109(7):309–318. DOI: 10.1179/2047773215Y.0000000030.
  13. Seller-Pérez G, Herrera-Gutiérrez ME, Maynar-Moliner J, Sánchez-Izquierdo-Riera JA, Marinho A, Do Pico JL. Estimating kidney function in the critically ill patients. Crit Care Res Pract 2013. 1–6. DOI: 10.1155/2013/529524.
  14. Waiker SS, Bonventre JV. Creatinine kinetics and the definition of acute kidney injury. J Am Soc Nephrol 2009;20(3):672–679. DOI: 10.1681/ASN.2008070669.
  15. Sunder S, Jayaraman R, Mahapatra H, Sathi S, Ramanan V, Kanchi P, et al. Estimation of renal function in the intensive care unit: the covert concepts brought to light. J Intensive Care 2014;2(1):1–7. DOI: 10.1186/2052-0492-2-31.
  16. MacDonald J, Moore J, Davey V, Pickering S, Dunne T. The weight debate. J Intensive Care Soc 2015;16(3):234–238. DOI: 10.1177/1751143714565059.
  17. Ferrari F, Sartori M, Milla P. Antibiotic adjustment in continuous renal replacement therapy. In: Ronco C, Bellomo R, Kellum JA, Ricci Z. Critical Care Nephrology. 3rd ed., Canada: Elsevier; 2019. pp. 1051–1067.e1. DOI: 10.1016/B978-0-323-44942-7.00175-8.
  18. Bilbao-Meseguer I, Rodríguez-Gascón A, Barrasa H, Isla A, Solinís MÁ. Augmented renal clearance in critically ill patients: A systematic review. Clin Pharmacokinet 2018;57(9):1107–1121. DOI: 10.1007/s40262-018-0636-7.
  19. Gonçalves-Pereira J, Póvoa P. Antibiotics in critically ill patients: a systematic review of the pharmacokinetics of β-lactams. Crit Care 2011;15(5):R206. DOI: 10.1186/cc10441.
  20. Villa G, Neri M, Bellomo R, Cerda J, De Gaudio AR, De Rosa S, et al. Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications. Crit Care 2016;20(1):283. DOI: 10.1186/s13054-016-1456-5.
  21. Zhao W, Jacqz-Aigrain E. Principles of therapeutic drug monitoring. Handb Exp Pharmacol 2011;205:77–90. DOI: 10.1007/978-3-642-20195-0_3.
  22. Zeitlinger MA, Derendorf H, Mouton JW, Cars O, Craig WA, Andes D, et al. Protein binding: Do we ever learn? Antimicrob Agents and Chemother 2011;55(7):3067–3074. DOI: 10.1128/AAC.01433-10.
  23. Kuang D, Verbine A, Ronco C. Pharmacokinetics and antimicrobial dosing adjustment in critically ill patients during continuous renal replacement therapy. Clin Nephrol 2007;67(5):267–284. DOI: 10.5414/cnp67267.
  24. Farrokh S, Tahsili-Fahadan P, Ritzl EK, Lewin JJ, Mirski MA. Antiepileptic drugs in critically ill patients. Crit Care 2018;22(1):153. DOI: 10.1186/s13054-018-2066-1.
  25. Mahmoud SH. Antiepileptic drug removal by continuous renal replacement therapy: a review of the literature. Clin Drug Investig 2017;37(1):7–23. DOI: 10.1007/s40261-016-0457-0.
  26. Leo A, Hansch C, Elkins D. Partition coefficients and their uses. Chem Rev 1971;71(6):525–616. DOI: 10.1021/cr60274a001.
  27. Ward RA, Ronco C. Dialyzer and machine technologies: application of recent advances to clinical practice. Blood Purif 2006;24(1):6–10. DOI: 10.1159/000089429.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.