Related Experiment Video
Updated: May 17, 2026
07:29
Intravascular Delivery of Biologics to the Rat Kidney
Published on: September 1, 2016
Drug dosing during continuous renal replacement therapies
1Department of Pharmacy Services and Department of Clinical Pharmacy and Outcomes Sciences, Medical University of South Carolina, Charleston, South Carolina.
Summary
Continuous renal replacement therapies (CRRT) enhance drug removal more than intermittent hemodialysis, risking subtherapeutic drug levels. Careful monitoring and dose adjustments are crucial for critically ill patients undergoing CRRT.
Area of Science:
- Nephrology
- Pharmacology
- Critical Care Medicine
Background:
- Continuous renal replacement therapies (CRRT) manage fluid overload and renal failure in critically ill patients.
- CRRT's continuous nature offers hemodynamic stability compared to intermittent hemodialysis.
- Drug removal during CRRT is influenced by modality, flow rates, filter type, and residual renal function.
Purpose of the Study:
- To summarize publications analyzing drug removal during CRRT.
- To highlight the variability and efficiency of drug clearance in CRRT.
- To inform dosing strategies for medications in patients receiving CRRT.
Main Methods:
- Annotated bibliography of studies on drug removal during CRRT.
- Inclusion of CRRT settings and drug clearance values from each study.
- Synthesis of findings on factors affecting drug removal.
Main Results:
- CRRT modalities are generally more efficient at drug removal than intermittent hemodialysis.
- Drug removal can approximate or exceed normal renal function, posing a risk of subtherapeutic dosing.
- Significant variability exists due to patient-specific and CRRT-specific factors.
Conclusions:
- Conventional dosing recommendations may lead to subtherapeutic drug levels in patients on CRRT.
- Close monitoring of serum drug concentrations and clinical status is essential.
- Findings are not universally generalizable; individualized assessment is critical.
Related Concept Videos
01:25Drug 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...
01:30Continuous 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...
01:26Extracorporeal 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...
01:11Renal 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...
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...
01:24Drug 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...
01:28Drug 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...