scholarly journals Challenges in Developing Evidence-Based Drug Dosing Guidelines for Adults and Children Receiving Renal Replacement Therapy

2009 ◽  
Vol 86 (5) ◽  
pp. 479-482 ◽  
Author(s):  
B A Mueller ◽  
W E Smoyer
Keyword(s):  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Evidence Based ◽  
Drug Dosing ◽  
Adults And Children

Acute pancreatitis and renal replacement therapy

2019 ◽  
pp. 179-190
Author(s):  
Clinton Lobo ◽  
Kim Gupta ◽  
Matt Thomas
Keyword(s):  
Critical Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critical Care Unit ◽  
Daily Practice ◽  
Care Staff ◽  
Evidence Based ◽  
Standard Textbook ◽  
Learning Points

This chapter is centred on a case study on pancreatitis and renal replacement therapy. This topic is one of the key challenging areas in critical care medicine and one that all intensive care staff will encounter. The chapter is based on a detailed case history, ensuring clinical relevance, together with relevant images, making this easily relatable to daily practice in the critical care unit. The chapter is punctuated by evidence-based, up-to-date learning points, which highlight key information for the reader. Throughout the chapter, a topic expert provides contextual advice and commentary, adding practical expertise to the standard textbook approach and reinforcing key messages.

scholarly journals Antimicrobial Doses in Continuous Renal Replacement Therapy: A Comparison of Dosing Strategies

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Anna P. Kempke ◽  
Abbie S. Leino ◽  
Farzad Daneshvar ◽  
John Andrew Lee ◽  
Bruce A. Mueller
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Drug Dose ◽  
Published Data ◽  
Pharmacokinetic Data ◽  
Drug Dosing ◽  
Dosing Strategies ◽  
Dose Recommendations

Purpose. Drug dose recommendations are not well defined in patients undergoing continuous renal replacement therapy (CRRT) due to limited published data. Several guidelines and pharmacokinetic equations have been proposed as tools for CRRT drug dosing. Dose recommendations derived from these methods have yet to be compared or prospectively evaluated.Methods. A literature search of PubMed, Micromedex, and Embase was conducted for 40 drugs commonly used in the ICU to gather pharmacokinetic data acquired from patients with acute and chronic kidney disease as well as healthy volunteers. These data and that obtained from drug package inserts were gathered for use in three published CRRT drug dosing equations. Doses calculated for a model patient using each method were compared to doses suggested in a commonly used dosing text.Results. Full pharmacokinetic data was available for 18, 31, and 40 agents using acute kidney injury, end stage renal disease, and normal patient data, respectively. On average, calculated doses differed by 30% or more from the doses recommended by the renal dosing text for >50% of the medications.Conclusion. Wide variability in dose recommendations for patients undergoing CRRT exists when these equations are used. Alternate, validated dosing methods need to be developed for this at-risk patient population.

scholarly journals Imipenem/Relebactam Ex Vivo Clearance during Continuous Renal Replacement Therapy

Antibiotics ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1184
Author(s):  
Soo Min Jang ◽  
Lenar Yessayan ◽  
Michael Dean ◽  
Gabrielle Costello ◽  
Ravi Katwaru ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Ex Vivo ◽  
Continuous Hemofiltration ◽  
Flow Rates ◽  
Drug Dosing ◽  
Dialysate Flow

(1) Purpose of this study: determination of adsorption and transmembrane clearances (CLTM) of imipenem and relebactam in ex vivo continuous hemofiltration (CH) and continuous hemodialysis (CHD) models. These clearances were incorporated into a Monte Carlo Simulation (MCS), to develop drug dosing recommendations for critically ill patients requiring continuous renal replacement therapy (CRRT); (2) Methods: A validated ex vivo bovine blood CH and CHD model using two hemodiafilters. Imipenem/relebactam and urea CLTM at different ultrafiltrate/dialysate flow rates were evaluated in both CH and CHD. MCS was performed to determine dose recommendations for patients receiving CRRT; (3) Results: Neither imipenem nor relebactam adsorbed to the CRRT apparatus. The CLTM of imipenem, relebactam, and urea approximated the effluent rates (ultrafiltrate/dialysate flow rates). The types of hemodiafilter and effluent rates did not influence CLTM except in a dialysis flow rate of 1 L/h and 6 L/h in the CHD with relebactam (p < 0.05). Imipenem and relebactam 200 mg/100 mg every 6 h were sufficient to meet the standard time above the MIC pharmacodynamic targets in the modeled CRRT regimen of 25 kg/mL/h. (4) Conclusions: Imipenem and relebactam are not removed by adsorption to the CRRT apparatus, but readily cross the hemodiafilter membrane in CH and CHD. Dosage adjustment of imipenem/relebactam is likely required for critically ill patients receiving CRRT.

scholarly journals Drug Dosing Considerations in Critically Ill Patients Receiving Continuous Renal Replacement Therapy

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 18 ◽  
Author(s):  
Soo Min Jang ◽  
Sergio Infante ◽  
Amir Abdi Pour
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Patient Specific ◽  
Therapeutic Drug ◽  
Intermittent Hemodialysis ◽  
Drug Dosing ◽  
Low Efficiency

Acute kidney injury is very common in critically ill patients requiring renal replacement therapy. Despite the advancement in medicine, the mortality rate from septic shock can be as high as 60%. This manuscript describes drug-dosing considerations and challenges for clinicians. For instance, drugs’ pharmacokinetic changes (e.g., decreased protein binding and increased volume of distribution) and drug property changes in critical illness affecting solute or drug clearance during renal replacement therapy. Moreover, different types of renal replacement therapy (intermittent hemodialysis, prolonged intermittent renal replacement therapy or sustained low-efficiency dialysis, and continuous renal replacement therapy) are discussed to describe how to optimize the drug administration strategies. With updated literature, pharmacodynamic targets and empirical dosing recommendations for commonly used antibiotics in critically ill patients receiving continuous renal replacement therapy are outlined. It is vital to utilize local epidemiology and resistance patterns to select appropriate antibiotics to optimize clinical outcomes. Therapeutic drug monitoring should be used, when possible. This review should be used as a guide to develop a patient-specific antibiotic therapy plan.

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