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Practical considerations to drug dosing in children with acute kidney injury

Farahnak Assadi1, Fatemeh Ghane Sharbaf2

  • 1Department of Pediatrics, Section of Nephrology, Rush University Medical Center, Chicago, IL, USA.

Journal of Clinical Pharmacology
|September 13, 2015
PubMed

Insights

Individualizing medication doses for pediatric acute kidney injury (AKI) is crucial. Dosing should consider drug pharmacokinetics, pharmacodynamics, and therapeutic drug monitoring for optimal outcomes and reduced toxicity.

Area of Science:

  • Pediatric Nephrology
  • Clinical Pharmacology
  • Critical Care Medicine

Background:

  • Medication dosing in pediatric acute kidney injury (AKI) requires careful consideration of drug pharmacokinetics and pharmacodynamics.
  • Accurate dosing is essential to optimize therapeutic outcomes and minimize drug toxicity in critically ill children.
  • Identifying at-risk patients using pediatric RIFLE criteria is vital for proactive management.

Purpose of the Study:

  • To review and outline optimal drug-dosing strategies for pediatric patients diagnosed with acute kidney injury.
  • To emphasize the importance of individualized dosing based on patient-specific factors and drug properties.
  • To discuss the utility of therapeutic drug monitoring and emerging kidney injury biomarkers in AKI management.

Main Methods:

  • Review of current literature on pharmacokinetic and pharmacodynamic principles in pediatric AKI.
  • Analysis of established and novel biomarkers for assessing kidney function and injury.
  • Evaluation of therapeutic drug monitoring protocols for optimizing medication efficacy and safety.

Main Results:

  • Individualized medication dosing, considering pharmacokinetic/pharmacodynamic principles, is recommended for pediatric AKI.
  • Serum creatinine, urine output, and volume status are key parameters for guiding drug dosing in the absence of specific urinary biomarkers.
  • Larger loading doses may be necessary for certain drugs, especially antimicrobials, due to fluid overload in early AKI stages.

Conclusions:

  • Optimizing medication dosing in pediatric AKI necessitates a personalized approach.
  • Therapeutic drug monitoring and the judicious use of kidney injury biomarkers can significantly improve patient care.
  • Implementing these strategies can lead to better therapeutic outcomes and reduced adverse events in children with AKI.

Keywords:
acute kidney injurychildrendrug dosingurinary biomarkers

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