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Updated: Jun 2, 2026
11:18
Direct Drug Delivery to Kidney via the Renal Artery
Published on: April 17, 2021
How to optimize drug delivery in renal replacement therapy
Linda Awdishu1, Josée Bouchard
1UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, California, USA.
Seminars in Dialysis
|April 27, 2011
Summary
Drug dosing in acute kidney injury (AKI) is complex due to altered pharmacokinetics and renal replacement therapy. Careful consideration of drug properties and patient factors is crucial to avoid adverse events from improper dosing.
Area of Science:
- Nephrology
- Clinical Pharmacology
Background:
- Drug dosing in acute kidney injury (AKI) presents significant challenges.
- Altered pharmacokinetics, inaccurate renal function estimation, and extracorporeal therapies complicate dosing.
- Patients with AKI are at high risk for adverse drug events due to potential under- or over-dosing.
Purpose of the Study:
- To review key factors influencing drug dosing in patients with AKI.
- To highlight the complexities of drug pharmacokinetics in renal failure.
- To discuss considerations for drug administration during continuous renal replacement therapy (CRRT) and sustained low-efficiency dialysis (SLEDD).
Main Methods:
- Review of pharmacokinetic changes in renal failure, including protein binding and metabolism.
- Evaluation of the accuracy of renal estimating equations in AKI.
- Discussion of drug clearance by extracorporeal therapies like CRRT and SLEDD.
Main Results:
- Renal estimating equations often overestimate renal clearance in AKI.
- Approximately 50% of patients with reduced renal clearance receive doses significantly higher than recommended.
- Therapeutic drug monitoring is recommended but often unavailable, necessitating clinical judgment.
Conclusions:
- Accurate drug dosing in AKI requires careful consideration of drug-specific properties and patient status.
- Clinicians must balance the risks of over- and under-dosing based on therapeutic index and clinical response.
- Management strategies for drug dosing in AKI patients on CRRT and SLEDD are critical for optimizing outcomes.
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