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Robot-Assisted Kidney Transplantation
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[Pharmacotherapy and kidney dysfunction].

F Keller1

  • 1Sektion Nephrologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland. frieder.keller@uniklinik-ulm.de.

Medizinische Klinik, Intensivmedizin Und Notfallmedizin
|July 8, 2018
PubMed
Summary
This summary is machine-generated.

Glomerular filtration rate (GFR) is crucial for drug dosing, not serum creatinine. Proper dosing, considering drug effect (peak or trough), administration method (infusion vs. bolus), and renal replacement therapy, ensures effective treatment.

Keywords:
Continuous infusionLoading dosePharmacodynamicsPharmacokineticsTarget concentration

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Area of Science:

  • Pharmacology
  • Nephrology
  • Critical Care Medicine

Background:

  • Serum creatinine is an unreliable marker for drug dose adjustment in patients with renal dysfunction.
  • Glomerular filtration rate (GFR) is the key determinant for appropriate drug dosing in renal impairment.
  • Acute kidney injury and chronic kidney disease necessitate careful consideration of drug pharmacokinetics.

Purpose of the Study:

  • To highlight the importance of GFR over serum creatinine for drug dose adjustments.
  • To provide guidance on dosing strategies for anti-infective agents based on their pharmacokinetic/pharmacodynamic properties.
  • To discuss drug dosing considerations in patients undergoing continuous renal replacement therapy (CRRT) and intermittent hemodialysis.

Main Methods:

  • Review of pharmacokinetic principles and their application in renal impairment.
  • Analysis of drug dosing strategies for concentration-dependent and time-dependent anti-infectives.
  • Evaluation of drug disposition and dosing adjustments during various renal replacement therapies.

Main Results:

  • Loading doses in acute conditions often match normal doses, with half-life guiding administration intervals.
  • Concentration-dependent drugs require high peak levels (e.g., daptomycin), while time-dependent drugs need high troughs (e.g., piperacillin).
  • Continuous renal replacement therapy (CRRT) may not always require antibiotic dose reduction, unlike intermittent hemodialysis, which necessitates re-dosing.

Conclusions:

  • GFR is essential for accurate drug dose adjustments, superseding serum creatinine levels.
  • Optimizing anti-infective dosing based on effect targets (peak/trough) and administration methods (infusion/bolus) improves efficacy.
  • Specific dosing strategies are required for CRRT and intermittent hemodialysis to maintain therapeutic drug concentrations.