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Related Concept Videos

Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

352
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...
352
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

143
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...
143
Continuous Renal Replacement Therapy01:30

Continuous Renal Replacement Therapy

597
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...
597
Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

208
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...
208
Acute Kidney Injury V: Interprofessional Care01:20

Acute Kidney Injury V: Interprofessional Care

207
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...
207
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

148
In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
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Harmonizing antibiotic regimens with renal replacement therapy.

Soo Min Jang1, Susan J Lewis2, Bruce A Mueller3

  • 1Department of Pharmacy Practice, Loma Linda University School of Pharmacy , Loma Linda, CA, USA.

Expert Review of Anti-Infective Therapy
|May 5, 2020
PubMed
Summary
This summary is machine-generated.

Critically ill patients with acute kidney injury often receive suboptimal antibiotic doses due to renal replacement therapy. Dosing must be adjusted to account for drug removal during dialysis to improve patient outcomes.

Keywords:
Renal replacement therapyacute kidney injuryantibioticspharmacodynamicspharmacokinetics

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Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Acute kidney injury (AKI) is common in critically ill patients, often necessitating renal replacement therapy (RRT).
  • Concurrent antibiotic therapy is crucial but complicated by altered pharmacokinetics and drug removal during RRT.
  • High mortality rates in these patients may be linked to ineffective antibiotic dosing.

Purpose of the Study:

  • To review the impact of different renal replacement therapies on antibiotic pharmacokinetics in critically ill patients.
  • To analyze the effectiveness of various antibiotic administration strategies in conjunction with RRT.
  • To provide expert recommendations for optimizing antibiotic dosing in AKI patients undergoing RRT.

Main Methods:

  • A literature review was conducted using the Medline database in December 2019.
  • Pertinent research on RRT modalities, antibiotic dosing strategies, and their effects on antibiotic serum concentrations was identified.
  • The review focused on intermittent hemodialysis, prolonged intermittent renal replacement therapy, and continuous renal replacement therapy.

Main Results:

  • Different RRT modalities significantly alter antibiotic serum concentration profiles.
  • Most studies indicate that critically ill AKI patients often receive insufficient antibiotic doses to reach therapeutic targets.
  • Antibiotic toxicity is a potential concern, but underdosing is more frequently observed.

Conclusions:

  • Renal replacement therapy complicates antibiotic management in critically ill AKI patients.
  • Clinicians must consider RRT-specific drug clearance when determining antibiotic doses.
  • Optimized antibiotic dosing strategies are essential to achieve desired pharmacodynamic targets and improve patient outcomes.