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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...
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...
Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
Acute Kidney Injury V: Interprofessional Care01:20

Acute Kidney Injury V: Interprofessional Care

Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
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...
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...

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Related Experiment Video

Updated: May 15, 2026

Use of a Hanging-weight System for Isolated Renal Artery Occlusion
07:54

Use of a Hanging-weight System for Isolated Renal Artery Occlusion

Published on: July 19, 2011

Antimicrobial dosing in acute renal replacement.

William H Fissell1

  • 1Department of Nephrology and Hypertension, Vanderbilt University, Nashville, TN 37232, USA. william.fissell@vanderbilt.edu

Advances in Chronic Kidney Disease
|December 26, 2012
PubMed
Summary

Antibiotic dosing in acute kidney injury (AKI) patients on continuous renal replacement therapy (CRRT) is often inadequate. Optimizing drug dosing is crucial for patient outcomes, especially given infection risks in AKI.

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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

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Last Updated: May 15, 2026

Use of a Hanging-weight System for Isolated Renal Artery Occlusion
07:54

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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
11:17

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

Area of Science:

  • Nephrology
  • Pharmacology
  • Critical Care Medicine

Background:

  • Acute kidney injury (AKI) is prevalent in hospitalized patients, linked to high morbidity and mortality.
  • Previous trials found no benefit in increasing renal replacement therapy (RRT) doses, contradicting earlier findings.
  • Infection is a primary cause of death in AKI, prompting investigation into RRT's impact on antibiotic clearance.

Purpose of the Study:

  • To examine the hypothesis that increased antibiotic clearance by RRT in AKI patients may lead to underdosing.
  • To discuss drug distribution and clearance principles in AKI.
  • To illustrate challenges in applying existing literature to clinical practice using piperacillin as an example.

Main Methods:

  • Review of existing clinical data and research on antibiotic dosing in AKI.
  • Analysis of drug distribution and clearance concepts in the context of AKI and CRRT.
  • Case illustration focusing on piperacillin dosing in AKI patients on CRRT.

Main Results:

  • Data indicate that many AKI patients on CRRT are underdosed with standard "one-size-fits-all" antibiotic regimens.
  • Published drug dosing data in AKI and dialysis often reflect outdated practices and may not align with current prescribing habits.
  • Challenges exist in translating general drug dosing literature to specific clinical scenarios in AKI.

Conclusions:

  • Standard antibiotic dosing in AKI patients receiving CRRT is frequently insufficient.
  • A more adaptable, situation-specific approach to drug dosing is needed for nephrologists and critical care specialists.
  • Individualized dosing strategies are essential to ensure effective antibiotic therapy in AKI patients on CRRT.