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A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
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Drug dosing optimization in critically ill children under continuous renal replacement therapy: from basic concepts
Mehdi Oualha1,2, Michael Thy2,3, Naïm Bouazza2
1Pediatric Intensive Care Unit, Necker Hospital, APHP-Centre, Université of Paris-Cité, Paris, France.
Expert Opinion on Drug Metabolism & Toxicology
|October 29, 2024
Summary
Optimizing drug dosage for critically ill children on Continuous Renal Replacement Therapy (CRRT) is complex. Model-informed precision dosing and therapeutic drug monitoring can aid in personalized pediatric CRRT drug regimens.
Area of Science:
- Pediatric Critical Care Pharmacology
- Renal Replacement Therapy
- Pharmacokinetic Modeling
Background:
- Drug dosage optimization in critically ill children receiving Continuous Renal Replacement Therapy (CRRT) presents significant challenges due to pharmacokinetic and pharmacodynamic variability.
- Understanding drug elimination mechanisms during CRRT is crucial for avoiding prescription errors, despite high inter- and intra-patient variability.
Purpose of the Study:
- To review the current understanding and methodologies for optimizing drug dosage in pediatric patients undergoing CRRT.
- To highlight the role of advanced modeling techniques in achieving precision dosing.
Main Methods:
- A systematic literature search was conducted in PubMed using specific keywords related to pediatric CRRT, pharmacokinetics, modeling, and therapeutic drug monitoring.
- The search included studies published until January 2024, irrespective of language or publication status.
Main Results:
- Population pharmacokinetic and physiologically based pharmacokinetic models are essential tools for suggesting adjusted dosage regimens.
- These models, derived from in-vivo and in-vitro studies, are challenging but remain the most appropriate approach for individualized dosing.
Conclusions:
- Educating pediatric intensivists on therapeutic drug monitoring and implementing individualized prescribing software like Model Informed Precision Dosing is a critical advancement.
- Further clinical studies are required to definitively demonstrate the patient benefit of these precision dosing strategies.
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