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Related Concept Videos

Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant01:25

Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant

In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...
Continuous Renal Replacement Therapy01:30

Continuous Renal Replacement Therapy

Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...
Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy01:26

Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy

Continuous Renal Replacement Therapy (CRRT) is an essential intervention for patients experiencing severe kidney dysfunction. This therapy offers a continuous mechanism for removing fluids and toxins from the bloodstream, leveraging the patient’s blood pressure to facilitate filtration through a specialized filter. This method contrasts with intermittent dialysis, providing a gentler and more consistent removal of waste products and excess fluid, which is particularly beneficial in critically...
Drug Accumulation During Multiple Dosing: Intermittent IV Infusions01:24

Drug Accumulation During Multiple Dosing: Intermittent IV Infusions

Intermittent intravenous (IV) infusion is a method of drug administration where medications are delivered over short infusion periods followed by intervals of no drug delivery. This approach helps to prevent sustained high drug concentrations in the bloodstream, reducing the risk of adverse effects associated with prolonged exposure. Unlike continuous infusion, steady-state concentrations may not be achieved during a single dosing cycle but can be reached through repeated...
Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration01:28

Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration

Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area. This equation is...

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Related Experiment Video

Updated: Jul 10, 2026

Intravascular Delivery of Biologics to the Rat Kidney
07:29

Intravascular Delivery of Biologics to the Rat Kidney

Published on: September 1, 2016

Drug dosing in continuous renal replacement therapy: general rules.

Miet Schetz1

  • 1Department of Intensive Care Medicine, Catholic University of Leuven, Leuven, Belgium. marie.schetz@uz.kuleuven.ac.be

Current Opinion in Critical Care
|November 3, 2007
PubMed
Summary

Drug dosing during continuous renal replacement therapy (CRRT) requires careful consideration of extracorporeal clearance and patient factors. Guidelines are proposed, emphasizing drug monitoring due to inherent unpredictability in critically ill patients.

Related Experiment Videos

Last Updated: Jul 10, 2026

Intravascular Delivery of Biologics to the Rat Kidney
07:29

Intravascular Delivery of Biologics to the Rat Kidney

Published on: September 1, 2016

Area of Science:

  • Pharmacology
  • Nephrology
  • Intensive Care Medicine

Background:

  • Continuous renal replacement therapy (CRRT) is vital for acute kidney injury in critically ill patients.
  • Concerns exist regarding extracorporeal drug removal, particularly antimicrobials, impacting treatment efficacy.
  • Variability in patient populations and CRRT settings limits generalizability of existing clinical studies.

Purpose of the Study:

  • To provide general guidelines for drug dosing during continuous renal replacement therapy.
  • To address concerns about antimicrobial removal and its impact on critically ill patients.
  • To offer a framework for adapting drug dosages in complex patient populations.

Main Methods:

  • Review of basic principles of drug removal during different CRRT modalities.
  • Proposal of general approaches for drug dosage adaptation.
  • Consideration of extracorporeal clearance, protein binding, and fractional clearance.

Main Results:

  • Drug dosing must account for extracorporeal clearance, influenced by CRRT parameters and membrane characteristics.
  • Hepatic, metabolic, and residual renal clearance are crucial factors in overall drug elimination.
  • Pharmacokinetic variability in critically ill patients necessitates careful dosing, especially for antimicrobials using pharmacodynamic principles.

Conclusions:

  • Drug dosage adaptation during CRRT involves multiple approaches with inherent unpredictability.
  • Maximal reliance on drug monitoring is essential for safe and effective therapy.
  • Tailoring antimicrobial dosing requires balancing efficacy and safety, particularly for drugs with narrow therapeutic indices.