Analgesics |
Codeine | Hepatic | 30-60 mg q4-6 | 100% [D] | 75% [D] | 50% [D] | Intermittent Hemodialysis (IHD): No data PD: No data CRRT: Dose for GFR 10-50 [D] |
Fentanyl | Hepatic | Individualized | 100% [D] | 75% [D] | 50% [D] | IHD: Not applicable Peritoneal Dialysis (PD): Not applicable CRRT: Dose for GFR 10-50 [B] |
Meperidine | Hepatic | 50-100 mg q3-4h | 100% [D] | 75% [D] | 50% [D] | IHD: Avoid PD: Avoid CRRT: Avoid [D] |
Methadone | Hepatic | 2.5-10 mg q6-8h | 100% [D] | 100% [D] | 50%-75% [D] | IHD: None PD: None CRRT: Dose for GFR: 10-50 [D] |
Morphine | Hepatic | 20-25 mg q4h | 100% [A] | 75% [A] | 50% [A] | IHD: None PD: None CRRT: Dose for GFR 10-50 [D] |
Naloxone | Hepatic | 2 mg IV | 100% [D] | 100% [D] | 100% [D] | IHD: Not applicable PD: Not applicable CRRT: Dose for GFR: 10-50 [D] |
Acetaminophen | Hepatic | 650 mg q4h | q4h [D] | q6h [D] | q8h [D] | IHD: None PD: None CRRT: Dose for GFR: 10-50 [B] |
Aspirin | Hepatic | 650 mg q4h | q4h [B] | q4-6h [B] | Avoid [B] | IHD: Dose after dialysis PD: None CRRT: Dose for GFR: 10-50 [D] |
Antihypertensive and Cardiovascular Agents |
Clonidine | 62 | 0.1-0.6 mg bid | q12h [B] | q12-24h [B] | q24h [B] | IHD: Dose after dialysis [B] PD: Dose for GFR < 10 [B] CRRT: Dose for GFR 10-50 [D] |
Methyldopa | 25-40 | 250-500 mg q8 | q8h [B] | q8-12h [B] | q12-24h [B] | IHD: Dose after dialysis [D] PD: Dose for GFR < 10 [D] CRRT: Dose for GFR 10-50 [D] |
Prazosin | < 5 | 1-15 mg bid-tid | 100% [A] | 100% [D] | 100% [D] | IHD: None PD: None [D] CRRT: Not applicable |
Terazosin | 20-30 | 1 mg hs Second dose: 1-20 mg q24h | 100% [A] | 100% [A] | 100% [A] | IHD: None [D] PD: None [D] CRRT: Not applicable |
Candesartan | 52 | 16-32 mg q24 | 100% [A] | 100% [A] | 100% [A] | IHD: No dose adjustment [A] PD: No dose adjustment [A] CRRT: Dose for GFR 10-50 [D] |
Irbesartan | < 5 | 150-300 mg q24 | 100% [A] | 100% [A] | 100% [A] | IHD: No dose adjustment [A] PD: No dose adjustment [D] CRRT: Dose for GFR 10-50 [D] |
Losartan | 4-10 | 25-100 mg q24 | 100% [A] | 100% [A] | 100% [A] | IHD: None [A] PD: None [A] CRRT: Dose for GFR 10-50 [D] |
Valsartan | 13 | 80-320 mg q24h | 100% [B] | 100% [B] | 100% [D] | IHD: None [A] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Benazepril | 54 | 10 mg q24h Second dose: 10-40 mg q12-24h | 100% [A] | 50%-75% [A] | 25%-50% [D] | IHD: None [D] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Captopril | 40-50 | 25-50 mg q8h Second dose: 50-150 mg q8-12h | 100% q8-12h [A] | 75% q12-18h [A] | 50% q24h [A] | IHD: Dose after dialysis [A] PD: Dose for GFR 10-50 [A] CRRT: Dose for GFR 10-50 [D] |
Enalapril | 88 | 5-20 mg q12-24h | 100% [A] | 50%-100% [A] | 25% [A] | IHD: Dose after dialysis [A] PD: Dose for GFR < 10 [D] CRRT: Dose for GFR 10-50 [D] |
Enalaprilat | 88 | 1.25-5 mg IV over 5 min q6h | 100% [A] | 50%-100% [A] | 25%-50% [D] | IHD: Dose after dialysis [A] PD: Dose for GFR < 10 [D] CRRT: Dose for GFR 10-50 [D] |
Lisinopril | 88-100 | 5-10 mg q24h Second dose: 20-40 mg q24h | 100% [A] | 50%-75% [A] | 25%-50% [A] | IHD: Dose after dialysis [A] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Ramipril | 35 | 2.5 mg q24h Second dose: 5-10 mg q24h | 100% [A] | 25%-50% [A] | 25% [A] | IHD: Dose after dialysis [A] PD: Dose for GFR < 10 [D] CRRT: Dose for GFR 10-50 [D] |
Atenolol | 85 | 50-100 mg q24h | 50-100 mg q24h [A] | 25-50 mg q24h [A] | 25 mg q24h [A] | IHD: 25-50 mg after dialysis [A] PD: Dose for GFR < 10 [A] CRRT: Dose for GFR 10-50 [D] |
Carvedilol | < 2 | 3.125-6.25 mg q12-24h Second dose: 6.25-25 mg q12-24h | 100% [A] | 100% [A] | 100% [A] | IHD: None [A] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Esmolol | < 10 | 0.5 mg/kg infused over 1 min Second dose: 0.05 mg mg/kg/min for the next 4 min | 100% [A] | 100% [A] | 100% [A] | IHD: None [A] PD: None [A] CRRT: Dose for GFR 10-50 [D] |
Labetalol | < 5 | 100 mg bid Second dose: 200-400 mg bid | 100% [A] | 100% [A] | 100% [A] | IHD: None [A] PD: None [A] CRRT: Dose for GFR 10-50 [D] |
Metoprolol | 8-13 | 50-400 mg q24h | 100% [A] | 100% [A] | 100% [A] | IHD: None [A] PD: None [A] CRRT: Dose for GFR 10-50 [D] |
Nadolol | 90 | 40 mg q24h Second dose: 40-240 mg q24h | q24h [A] | q24-48h [A] | q40-60h [A] | IHD: Dose after dialysis [A] PD: Dose for GFR < 10 [A] CRRT: Dose for GFR 10-50 [D] |
Propranolol | < 5 | 80-160 mg bid | 100% [A] | 100% [A] | 100% [A] | IHD: None [A] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Timolol | 15 | 10-30 mg bid | 100% [A] | 100% [A] | 100% [A] | IHD: No dose adjustment [A] PD: No dose adjustment [D] CRRT: Dose for GFR 10-50 [D] |
Hydralazine | 25 | 25-50 mg tid | q8h [A] | q8h [A] | q8h [A] | IHD: Dose after dialysis [D] PD: Dose for GFR < 10 [D] CRRT: Dose for GFR 10-50 [D] |
Minoxidil | 15-20 | 5-30 mg bid | 100% [A] | 100% [A] | 100% [A] | IHD: Dose after dialysis [D] PD: Dose for GFR < 10 [D] CRRT: Dose for GFR 10-50 [D] |
Nitroprusside | < 10 | 0.25-8 mcg/kg/min Second dose: by infusion | 100% [A] | 100% [A] | Avoid [D] | IHD: Avoid [D] PD: Avoid [D] CRRT: Dose for GFR 10-50 [D] |
Procainamide | 80 | 500 mg q6-8h | 100% q6-8h [A] | 50% q8-12h [A] | 25% q12-18h [A] | IHD: None PD: None CRRT: Dose for GFR 10-50 [D] |
Adenosine | < 5 | 3-6 mg IV bolus | 100% [D] | 100% [D] | 100% [D] | IHD: None PD: None CRRT: Dose for GFR 10-50 [D] |
Amiodarone | < 5 | 800-2000 mg load, then 200-600 mg q24h | 100% [A] | 100% [A] | 100% [A] | IHD None PD: None CRRT: Dose for GFR 10-50 [D] |
Bretylium | 75 | 5-30 mg/kg load, then 5-10 mg IV q6h | 100% [A] | 25%-50% [A] | 25% [A] | IHD: None PD: None CRRT: Dose for GFR 10-50 [D] |
Disopyramide | 35-65 | 100-200 mg q6h | q8h [A] | q12-24h [A] | q24-48h [A] | IHD: None PD: None CRRT: Dose for GFR 10-50 [D] |
Flecainide | 43 | 50-100 mg q12h | 100% [A] | 50% [A] | 50% [A] | IHD: None PD: None CRRT: Dose for GFR 10-50 [D] |
Lidocaine | 10 | 50 mg over 2 min, repeat q5 min ×3 Second dose: 1-4 mg/min | 100% [D] | 100% [D] | 100% [D] | IHD: None PD: None CRRT: Dose for GFR 10-50 [B] |
Procainamide | 59-75 | 1000-2500 mg q12h | q4h [A] | q6-12h [A] | q8-24h [A] | IHD: Follow levels [A] PD: None [A] CRRT: Dose for GFR 10-50, monitor serum concentration [D] |
Propafenone | < 1 | 150 mg q8h Second dose: 150-300 mg q8h | 100% [A] | 100% [A] | 100% [A] | IHD: None [A] PD: None [A] CRRT: Dose for GFR 10-50 [D] |
Quinidine | 20 | 300-600 mg q8-12h | 100% [A] | 100% [A] | 100% [A] | IHD: Dose after dialysis [D] PD: None [D] CRRT: Dose for GFR 10-50, monitor serum concentration [D] |
Sotalol | 80-90 | 80 mg q12h Second dose: 120-160 mg q12h | q12h [A] | q24-48h [A] | q48-72h [A] | IHD: Dose after dialysis [D] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Amlodipine | < 10 | 2.5-10 mg q24h | 100% [A] | 100% [D] | 100% [D] | IHD: None [D] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Diltiazem | < 5 | 180-240 mg q24h Second dose: 180-240 mg q24h | 100% [A] | 100% [A] | 100% [A] | IHD: None [A] PD: None [A] CRRT: Dose for GFR 10-50 [D] |
Nicardipine | < 1 | 20-40 mg pot id | 100% [D] | 100% [D] | 100% [D] | IHD: None [D] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Nifedipine | < 5 | 10-30 mg q8h | 100% [A] | 100% [A] | 100% [A] | IHD: No dose adjustment [A] PD: No dose adjustment [A] CRRT: Dose for GFR 10-50 [D] |
Nimodipine | < 10 | 30 mg q8h | 100% [D] | 100% [D] | 100% [D] | IHD: None PD: None CRRT: Dose for GFR 10-50 [D] |
Verapamil | < 3 | 180-480 mg q24h | 100% [A] | 100% [A] | 100% [A] | IHD: None [A] PD: None [A] CRRT: Dose for GFR 10-50 [B] |
Digoxin | 76-85 | 1.0-1.5 mg load, then 0.25-0.5 mg q24h | 100% q24h [A] | 25%-75% q36h [A] | 10%-25% q48h [A] | IHD: None PD: None CRRT: Dose for GFR 10-50, monitor serum concentration [D] |
Acetazolamide | 100 | 250 mg q6-12h | q6h [A] | q12h [A] | Avoid [A] | IHD: No data PD: No data CRRT: Dose for GFR 10-50 [D] |
Furosemide | 50-80 | 20-300 mg q12-24h | 100% [A] | 100% [A] | 100% [A] | IHD: None [A] PD: None [A] CRRT: Not applicable [D] |
Hydrochlorothiazide | 90 | 6.25-200 mg q24h | 100% [A] | 100% [A] | Ineffective [A] | IHD: Not applicable [D] PD: Not applicable [D] CRRT: Not applicable [D] |
Metolazone | 70 | 5-20 mg q24h | 100% [A] | 100% [A] | 100% [D] | IHD: None [D] PD: None [D] CRRT: Not applicable [D] |
Spironolactone | 20-30 | 25 mg tid-qid | q6-12h [D] | q12-24h [D] | Avoid [D] | IHD: Not applicable PD: Not applicable CRRT: Avoid [D] |
Dobutamine | < 10 | 2.5 mcg/kg/min | 100% [D] | 100% [D] | 100% [D] | IHD: No data PD: No data CRRT: Dose for GFR 10-50 [D] |
Midodrine | 75-80 | No data | 5-10 mg q8h [D] | 5-10 mg q8h [D] | No data [D] | IHD: 5 mg q8h PD: No data CRRT: Dose for GFR 10-50 [D] |
Milrinone | 80-85 | 15-75 mcg/kg IV load, then 2.5-15 mg po q6h | 100% [A] | 100% [A] | 50%-75% [A] | IHD: No data PD: No data CRRT: Dose for GFR 10-50 [D] |
Isosorbide dinitrate | < 1 | 2.5-5 mg 15 min before activity | 100% [A] | 100% [A] | 100% [A] | IHD: None [A] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Isosorbide mononitrate | < 5 | 30-60 mg q24h Second dose: 60-240 mg q24h | 100% [D] | 100% [D] | 100% [D] | IHD: Dose after dialysis [D] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Nitroglycerine | < 1 | Many routes and methods | 100% [D] | 100% [D] | 100% [D] | IHD: No data PD: No data CRRT: Dose for GFR 10-50 [D] |
Antimicrobials | | | | | | |
Amikacin | 95 | 7.5 mg/kg q12h or 15 mg/kg qd | 100% q12or 24h [B] | 100% q24-72h by levels [B] | 100% q48-72h by levels [B] | IHD: 1/2 full dose after dialysis PD: 15-20 mg/L/d CRRT: Dose for GFR 10-50, monitor levels [B] |
Gentamycin | 95 | 1.7 mg/kg q8h or 5-7 mg/kg/qd | 100% q8-24h [A] | 100% q12-48h by levels [A] | 100% q48-72h by levels [A] | IHD: 1/2 full dose after dialysis PD: 3-4 mg/L/d CRRT: Dose for GFR 10-50, monitor levels [A] |
Kanamycin | 50-90 | 7.5 mg/kg q12h | 100% q12 or 24h [D] | 100% q24-72h by levels [D] | 100% q48-72h by levels [D] | IHD: 1/2 full dose after dialysis PD: 15-20 mg/L/d CRRT: Dose for GFR 10-50, monitor levels [D] |
Streptomycin | 70 | 1-2 g q6-12h (1.0 g q24h for tuberculosis) | q24h [D] | q24-72h [D] | q72-96h [D] | IHD: 1/2 full dose after dialysis PD: 20-40 mg/L/d CRRT: Dose for GFR 10-50, monitor levels [D] |
Tobramycin | 95 | 1.7 mg/kg q8h or 5-7 mg/kg qd | 100% q8-24h [A] | 100% q24-48h by levels [A] | 100% q48-72h by levels [A] | IHD: 1/2 full dose after dialysis PD: 3-4 mg/L/d CRRT: Dose for GFR 10-50, monitor levels [B] |
Cefaclor | 70 | 250-500 mg q8 | 100% [B] | 100% [B] | 100% [B] | IHD: 250-500 mg after dialysis [B] PD: 250-500 mg q8h CRRT: Not applicable |
Cefazolin | 75-95 | 0.25-2 g q6h | 100% q8h [A] | 100% q12h [A] | 50% q24-48h [A] | IHD: 15-20 mg/kg after dialysis PD: 0.5 g q12 CRRT: Doses for GFR 10-50 [D] |
Cefepime | 85 | 250-2000 mg q8-12h | 100% [A] | 50%-100% q24h [A] | 25%-50% q24h [A] | IHD: Doses for GFR < 10 PD: Doses for GFR < 10 CRRT: 1-2 g q12h [A] |
Cefotaxime | 60 | 1-2 g q6-12h | q6h [A] | q6-12h [A] | q24h or 1/2 dose [A] | IHD: 0.5-2 g after dialysis PD: 1 g/d CRRT: 1 g q12h [B] |
Cefotetan | 75 | 1-2 g q12h | 100% [A] | 1-2 g q24h [A] | 1-2 g q48h [A] | IHD: 1 g after dialysis PD: 1 g/d CRRT: Doses for GFR 10-50 [B] |
Cefoxitin | 80 | 1-2 g q6-8h | q6-8h [A] | q8-12h [A] | q24-48h [A] | IHD: 1 g after dialysis PD: 1 g/d CRRT: Doses for GFR 10-50 [D] |
Ceftazidime | 60-85 | 1-2 g q8h | q8-12h [A] | q12-24h [A] | q24-48h [A] | IHD: 1 g after dialysis PD: 0.5 g/d CRRT: 1-2 g q12 or 2 g load followed by 3 g/d continuous infusion [A] |
Ceftriaxone | 30-65 | 0.25-2 g q12-24h | 100% [A] | 100% [A] | 100% [A] | IHD: None PD: 1 g q12 CRRT: Doses for GFR 10-50 [A] |
Cefuroxime Axetil | 90 | 250-500 mg q12 | 100% [A] | 100% [A] | 100% [A] | IHD: Dose after dialysis PD: None CRRT: Not applicable |
Cephalexin | 90 | 250-500 mg q6h | q6-8h [A] | q8-12h [A] | q12-24h [A] | IHD: Dose after dialysis PD: Dose for GFR < 10 CRRT: Not applicable |
Azithromycin | 6-12 | 250-500 mg q24h | 100% [A] | 100% [A] | 100% [A] | IHD: None PD: None CRRT: Dose for GFR 10-50 [D] |
Clarithromycin | 20-30 | 250-500 mg q12h Second dose: 1 g q24h | 100% [D] | 50%-100% [D] | 50% [D] | IHD: No data, Dose after dialysis PD: None CRRT: Dose for GFR 10-50 [D] |
Erythromycin | 15 | 250-500 mg q6h | 100% [A] | 100% [A] | 100% [A] | IHD: None PD: None CRRT: Dose for GFR 10-50 [D] |
Aztreonam | 75 | 500 mg-2 g q8-12h | 100% [A] | 50% [A] | 25% [A] | IHD: 0.5 g after dialysis PD: Dose for GFR < 10 CRRT: 1000 mg q12h [D] |
Chloramphenicol | 10 | 12.5 mg/kg q6h | 100% [D] | 100% [D] | 100% [D] | IHD: None PD: None CRRT: Dose for GFR 10-50 [D] |
Clindamycin | 10 | 150-450 mg q6h | 100% [D] | 100% [D] | 100% [D] | IHD: None PD: None CRRT: Dose for GFR 10-50 [D] |
Dapsone | 5-20 | 50-100 mg q24h (for malaria prophylaxis once weekly) | No data 100% [D] | No data [D] | No data [D] | IHD: No data, None PD: No data, Dose for GFR < 10 CRRT: Dose for GFR 10-50 [D] |
Daptomycin | 78 | 4 mg/kg q24h | 100% [D] | 100% q24-48h [D] | 100% q48h [D] | IHD: Dose for GFR < 10 [D] PD: Dose for GFR < 10 [D] CRRT: 8 mg/kg q48h [C] |
Ertapenem | 38 | 1 g q24h | 100% [D] | 100% [D] | 50% [D] | IHD: 500 mg qd for GFR < 30, supplemental 150 mg after dialysis if daily dose given less than 6 g before start of dialysis [B] PD: Dose for GFR < 10 [D] CRRT: 100%, no adjustment needed unless GFR < 30 [B] |
Imipenem | 20-70 | 0.25-1 g q6h | 100% [A] | 50% [A] | 25% [A] | IHD: Dose after dialysis PD: Dose for GFR < 10 CRRT: 500 mg q6h [A] |
Linezolid | 30 | 600 mg q12h | 100% [B] | 100% [B] | 100% [B] | IHD: No dose adjustment [B] PD: No dose adjustment [B] CRRT: 600 mg q12h [A] |
Meropenem | 65 | 1-2 g q8h | 100% [D] | 100% q12h [D] | 100% q24h [D] | IHD: Dose after dialysis PD: Dose for GFR < 10 CRRT: 1-2 g q12h [A] |
Metronidazole | 20 | 250-500 mg q8-12h | 100% [A] | 100% [A] | 100% [A] | IHD: Dose after dialysis PD: Dose for GFR < 10 CRRT: Dose for GFR 10-50 [B] |
Nitrofurantoin | 30-40 | 50-100 mg q6h | Avoid < 60 [D] | Avoid [D] | Avoid [D] | IHD: Not applicable PD: Not applicable CRRT: Avoid |
Quinupristin/Dalfopristin | Quinupristin 5% Dalfopristin 0% | 7.5 mg/kg q8h | 100% [B] | 100% [B] | 100% [B] | IHD: No dose adjustment [D] PD: No dose adjustment [B] CRRT: Dose for GFR 10-50 [C] |
Rifaximin | 0.023 | 200 mg pot id | 200 mg pot id [D] | 100% [D] | 100% [D] | IHD: – PD: – CRRT: Has not been studied in renally impaired patients [D] |
Sulfamethoxazole | 70 | 1 g q8h | q12h [D] | q18h [D] | q24h [D] | IHD: 1 g after dialysis PD: 1 g/d CRRT: 2.5-5 mg/kg q12h for mild/moderate infections, 10 mg/kg q12 for severe infection [B] |
Trimethoprim | 60-80 | 100 mg q12h | q12h [D] | q12h for GFR > 30, q18h for GFR 10-30 [D] | q24h [D] | IHD: Dose after dialysis PD: Dose for GFR < 10 CRRT: 2.5-5 mg/kg q12h for mild/moderate infections, 10 mg/kg q12h for severe infection [D] |
Vancomycin | 90-100 | 500 mg-1.25 g q12h | 1 g q12-24h [A] | 1 g q24-96h [A] | 1 g q4-7d [A] | IHD: Dose for GFR < 10 PD: Dose for GFR < 10 CRRT: Dose for GFR 10-50 [A] |
Amoxicillin | 50-70 | 250-500 mg q8h | q8h [A] | q8-12h [A] | q24h [A] | IHD: Dose after dialysis PD: 250 mg q12h CRRT: Not applicable |
Ampicillin | 30-90 | 250 mg-2 g q6h | q6h [A] | q6-12h [A] | q12-24h [A] | IHD: Dose after dialysis PD: 250 mg q12h CRRT: Dose for GFR 10-50 |
Nafcillin | 35 | 1-2 g q4-6h | 100% [D] | 100% [D] | 100% [D] | IHD: None PD: None CRRT: Dose for GFR 10-50 [B] |
Penicillin G | 60-85 | 0.5-4 million U q4-6h | 100% [D] | 75% [D] | 20%-50% [D] | IHD: Dose after dialysis PD: Dose for GFR < 10 CRRT: Dose for GFR 10-50 [B] |
Piperacillin | 75-90 | 3-4 g q6h | q6h [A] | q6-12h [A] | q12h [A] | IHD: 2 g plus 1 g after dialysis PD: Dose for GFR < 10 CRRT: Dose for GFR 10-50 [A] |
Piperacillin/Tazobactam | Piperacillin 60%-80% Tazobactam 10%-20% | 3.375-4.5 g q6-8h | 100% [B] | 2.25 g q6-8h [B] | 2.25 g q8h [B] | IHD: Dose for GFR < 10, 1.125 g after HD [B] PD: 4.5 g q12h [B] CRRT: 4.5 g q8h |
Ciprofloxacin | 50-70 | 500-750 mg (400 mg if IV) q12h | 100% [A] | 50%-75% [A] | 50% [A] | IHD: 250 mg q12h (200 mg if IV) PD: 250 mg q8h (200 mg if IV) CRRT: 400 mg q24h [A] |
Gatifloxacin | 70-95 | 400 mg q24h | 100% [B] | 400 mg initially, then 200 mg q24h [B] | 400 mg initially, then 200 mg q24h [B] | IHD: Dose for GFR < 10 [B] PD: Dose for GFR < 10 [B] CRRT: Dose for 30-50 [D] |
Levofloxacin | 67-87 | 250-750 mg q24 | 100% [A] | 250-750 mg q24-48h (500-750 mg initial dose) [A] | 250-500 mg q48h (500 mg initial dose) [A] | IHD: Dose for GFR < 10 PD: Dose for GFR < 10 CRRT: 500 mg q48h [A] |
Moxifloxacin | 20 | 400 mg q24h | 100% [B] | 100% [B] | 100% [B] | IHD: No data [D] PD: No data [D] CRRT: 400 mg q24h [B] |
Ofloxacin | 68-80 | 200-400 mg q12h | 100% [A] | 200-400 mg q24h [A] | 200 mg q24h [A] | IHD: 100-200 mg after dialysis PD: Dose for GFR < 10 CRRT: 300 mg q24h [B] |
Doxycycline | 35-45 | 100 mg q12h | 100% [D] | 100% [D] | 100% [D] | IHD: None PD: None CRRT: Dose for GFR 10-50 [B] |
Minocycline | 6-10 | 100 mg q12h | 100% [D] | 100% [D] | 100% [D] | IHD: None PD: None CRRT: Not applicable |
Tetracycline | 48-60 | 250-500 mg bid-qid | q8-12h [D] | q12-24h [D] | q24h [D] | IHD: None PD: None CRRT: Not applicable |
Amphotericin B (lipid complex) | < 1 | 5 mg/kg q24h | q24h [A] | q24h [A] | q24h [A] | IHD: None PD: None CRRT: Dose for GFR 10-50 [A] |
Caspofungin | < 2 | 70 mg initial dose, then 50 mg q24h | No change [B] | No change [B] | No change [B] | IHD: No adjustment necessary [B] PD: No adjustment necessary [B] CRRT: 100% dose [D] |
Fluconazole | 70 | 100-400 mg q24h | 100% [A] | 50% [A] | 50% [A] | IHD: 100% after dialysis PD: Dose for GFR < 10 CRRT: 200-400 mg q24h [A] |
Flucytosine | 90 | 37.5 mg/kg q6h | q12h [D] | q12-24h [D] | q24-48h [D] | IHD: Dose after dialysis PD: 0.5-1 g/d CRRT: Dose for GFR 10-50 [B] |
Itraconazole | 35 | 100 mg q12h | 100% [A] | 100% [A] | 100% [A] | IHD: 100 mg q12-24h (oral only) PD: 100 mg q12-24h (oral only) CRRT: 100% [B] |
Ketoconazole | 13 | 200-400 mg q24h | 100% [D] | 100% [D] | 100% [D] | IHD: None PD: None CRRT: 100% [D] |
Voriconazole | < 2 | 6 mg/kg IV × 2 doses or 200 mg po q12 Second dose: 4 mg/kg IV or 200 mg po q12h | 100% [B] | 100% (IV not recommended) [B] | 100% (IV not recommended) [D] | IHD: No adjustment necessary [B] PD: No adjustment necessary [D] CRRT: 100% [B] |
Ethambutol | 75-90 | 15-25 mg/kg q24h | q24h [A] | q24-36h [A] | q48h | IHD: Dose after dialysis PD: Dose for GFR < 10 CRRT: Dose for GFR 30-50 [D] |
Isoniazid | 5-30 | 300 mg q24h | 100% [A] | 100% [A] | 100% [A] | IHD: Dose after dialysis PD: Dose for GFR < 10 CRRT: Dose for GFR 30-50 [D] |
Pyrazinamide | 1-3 | 15-30 mg/kg (up to 2.5 g) q24h | 100% [A] | 100% [A] | 50%-100% [A] | IHD: 40 mg/kg 24hr before each 3×/wk dialysis [B] PD: 100% [B] CRRT: Dose for GFR 10-50 [D] |
Rifabutin | 5-10 | 300 mg q24h | 100% [A] | 100% [A] | 100% [A] | IHD: None PD: None CRRT: 100% [B] |
Rifampin | 15-30 | 600 mg q24h | 100% [D] | 50%-100% [D] | 50%-100% [D] | IHD: None PD: Dose for GFR < 10 CRRT: Dose for GFR 30-50 [B] |
Atovaquone | < 1 | 750-1500 mg q12h | No data; 100% [D] | No data; 100% [D] | No data; 100% [D] | IHD: No data, None PD: No data, None CRRT: Dose for GFR 30-50 [D] |
Chloroquine | 40 | 2.5 g (for treatment; 1 g initially, then 0.5 g in 6 h, then 0.5 g daily for 2 d) | 100% [D] | 100% [D] | 50% [D] | IHD: Dose for GFR < 10 PD: Dose for GFR < 10 CRRT: Dose for GFR 10-50 [D] |
Mefloquine | < 1 | 1250 mg in 2 doses (750 mg initially, then 500 mg 12 h later) | 100% [D] | No data; 100% [D] | No data; 100% [D] | IHD: None PD: No data, None CRRT: Dose for GFR 10-50 [D] |
Pentamidine | < 5 | 4 mg/kg q24h | q24h [A] | q24h [A] | q24-36h [A] | IHD: Dose for GFR < 10, 0.75 g after each HD PD: Dose for GFR < 10 CRRT: Dose for GFR 30-50 [D] |
Primaquine | 1 | 15 mg (base) q24h | No data; 100% [D] | No data; 100% [D] | No data; 100% [D] | IHD: No data, None PD: No data, None CRRT: Dose for GFR 30-50 [D] |
Pyrimethamine | 15-30 | 50-75 mg q24h | 100% [D] | 100% [D] | 100% [D] | IHD: None PD: None CRRT: Dose for GFR 30-50 [D] |
Acyclovir | 40-70 | 5-10 mg/kg q8h | 100% q8 [D] | 100% q12-24h [D] | 50% q24h [D] | IHD: Dose after dialysis PD: Dose for GFR < 10 CRRT: 5-10 mg/kg q24h [A] |
Famciclovir | 50-65 | 500 mg q8h for herpes zoster; 125 mg q12h for genital herpes | 100% [D] | q12-24h [D] | 50% q24h [D] | IHD: Dose after dialysis PD: No data CRRT: Not applicable, recommend IV ganciclovir |
Foscarnet | 85 | 40-60 mg/kg q8h Second dose: to 90 mg/kg q12h | 28 mg/kg [A] | 15 mg/kg [A] | 6 mg/kg [A] | IHD: Dose after dialysis PD: Dose for GFR < 10 CRRT: Cytomegalovirus (CMV) induct; 60 mg q24h; CMV main; 60 mg q48 [B] |
Ganciclovir | 90-100 | 5 mg/kg q12h | 50% q12-24h [D] | 25%-50% q24h [D] | 25% 3 wk [D] | IHD: 25% 3×/wk PD: Dose for GFR < 10 CRRT: Induction: 2.5 mg/kg q24h, main: 1.25 mg/kg q24h [B] |
Valacyclovir | < 1 | 500 mg q12h Second dose: to 1000 mg q8h | 100% [D] | Full dose q12-24h [D] | 0.5 g q24h [D] | IHD: Dose after dialysis PD: Dose for GFR < 10 CRRT: Not applicable, recommend IV form |
Valganciclovir | > 90 | 900 mg bid (induction) 900 mg daily (maintenance) | Induction GFR 40-59; 450 mg bid GFR 25-39; 450 mg qd GFR 10-24 450 mg q2d [A] | Maintenance GFR 40-59; 450 mg qd GFR 25-39 450 mg q2d GFR 10-24 450 mg twice weekly [A] | | IHD: Avoid PD: Avoid CRRT: based on GFR |
Anticoagulants |
Alteplase | No data | 60 mg over 1 h, then 20 mg/h for 2 h | 100% [D] | 100% [D] | 100% [D] | IHD: No data [D] PD: No data [D] CRRT: Dose for GFR 10-50 [D] |
Dipyridamole | No data | 50 mg tid | 100% [D] | 100% [D] | 100% [D] | IHD: None [D] PD: Dose for GFR < 10 [D] CRRT: Not applicable |
Heparin | None | 75 U/kg load, then 0.5 U/kg/min | 100% [A] | 100% [A] | 100% [A] | IHD: None [A] PD: None [A] CRRT: Dose for GFR 10-50 [D] |
Low molecular weight heparin (LMWH) | No data | 30-40 mg bid | 100% [B] | 100% [B] | 50% [B] | IHD: Not applicable [D] PD: Dose for GFR < 10 [D] CRRT: 50% and monitor Xa [D] |
Streptokinase | None | 250,000 U load, then 100,000 U/h | 100% [B] | 100% [B] | 100% [B] | IHD: Not applicable [D] PD: Not applicable [D] CRRT: Dose for GFR 10-50 [D] |
Urokinase | No data | 4400 U/kg load, then 4400 U/kg qh | 100% [B] | 100% [B] | 100% [B] | IHD: None [D] PD: None [D] CRRT: Dose for GFR 10-50, not available [D] |
Warfarin | None | 10-15 mg load, then 2-10 mg q24h | 100% [A] | 100% [A] | 100% [A] | IHD: None [B] PD: None [B] CRRT: 100% [D] |
Anticonvulsants | | | | | | |
Carbamazepine | 2-3 | 200 mg bid Second dose: to 1200 mg q24h | 100% [A] | 100% [A] | 75% [D] | IHD: Dose for FR < 10 give after dialysis [B] PD: Dose for GFR < 10 [D]CRRT: 100% [B] |
Clonazepam | < 1 | 0.5 mg tid | 100% [D] | 100% [D] | 100% [D] | IHD: None [D] PD: No data CRRT: Not applicable |
Fosphenytoin | 2 | 15-20 mg PE/kg at 100-150 mg PE/min | 100% [B] | 100% [B] | 100% [B] | IHD: None [A] PD: None [B] CRRT: 100% [B] |
Gabapentin | 90 | 300-600 mg tid | 400 mg tid [A] | 300 mg q12-24h [A] | 300 mg qod [A] | IHD: 300 mg load, then 200-300 mg post HD [A] PD: 300 mg qod [D] CRRT: Dose for GFR 10-50 [D] |
Lamotrigine | 10 | 50 mg q12-24h (initially) 100-500 mg q24h (maintenance) | 100% [D] | 75% [D] | 10 mg qod [A] | IHD: 100 mg after dialysis [A] PD: Dose for GFR < 10 [D] CRRT: Decrease dose by 50% [B] |
Levetiracetam | 66 | 500-1500 mg q12h | 500-1000 mg q12h [A] | 250-750 mg q12h [A] | 500-1000 mg q24h [A] | IHD: 250-500 mg after dialysis [B] PD: Dose for GFR < 10 [D] CRRT: 250-750 mg q12h [D] |
Oxcarbazepine | 30 | 300-600 mg bid | 100% [A] | 75%-100% [A] | 50% [A] | IHD: Dose for GFR < 10, give after dialysis [D] PD: Dose for GFR < 10 [D] CRRT: Decrease dose by 50%, monitor levels [D] |
Phenobarbital | 19-31 | 50-100 mg q8-12h | q8-12h [D] | q8-12h [D] | q12-16h [D] | IHD: Dose before dialysis, 1/2 dose after dialysis [D] PD: 1/2 normal dose [B] CRRT: Normal dose and measure levels [B] |
Phenytoin | 2 | 100 mg tid | 100% [B] | 100% [B] | 100% [B] | IHD: None [A] PD: None [B] CRRT: 100% [B] |
Topiramate | 70-97 | 200 mg q12h | 100% [A] | 50% [A] | 25% [D] | IHD: Dose for normal renal function after dialysis [D] PD: Dose for GFR 10-50 [D] CRRT: Dose for GFR 10-50 [B] |
Valproic acid | < 5 | 500 mg q24h for 1 wk Second dose: 500-1000 mg q24h | 100% [D] | 100% [D] | 100% [D] | IHD: Dose after dialysis [D] PD: Dose for GFR < 10 [B] CRRT: None [D] |
Antihistamines | | | | | | |
Diphenhydramine | 2 | 25 mg tid-qid | 100% [D] | 100% [D] | 100% [D] | IHD: None [D] PD: None [D] CRRT: 100% [D] |
Famotidine | 65-80 | 20-40 mg qhs | 50%-75% [D] | 10%-50% [D] | 10% [D] | IHD: Dose after dialysis [A] PD: Dose for GFR < 10 [A] CRRT: Dose for GFR 10-50 [B] |
Ranitidine | 80 | 150-300 mg qhs | 75% [A] | 150 mg q12-24h [A] | 75-150 mg q24h [A] | IHD: Dose after dialysis [D] PD: Dose for GFR < 10 [D] CRRT: Dose for GFR 10-50 [D] |
Antiparkinson Agents | | | | | | |
Carbidopa | 30 | 1 tab tid Second dose: to 6 tabs daily | 100% [D] | 100% [D] | 100% [D] | IHD: No data PD: No data CRRT: Dose for GFR 10-49 [D] |
Levodopa | None | 250-500 mg bid Second dose: to 8 g q24h | 100% [B] | 50%-100% [B] | 50%-100% [B] | IHD: Dose after dialysis [D] PD: Dose for GFR < 10 [D] CRRT: Dose for GFR 10-50 [D] |
Antithyroid Drugs | | | | | | |
Methimazole | 7 | 5-20 mg tid | 100% [B] | 100% [B] | 100% [B] | IHD: None [D] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Propylthiouracil | < 10 | 100 mg tid | 100% [A] | 100% [A] | 100% [A] | IHD: None [D] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Arthritis and Gout Agents | | | | | | |
Allopurinol | 30 | 300 mg q24h | 75% [B] | 50% [B] | 25% [B] | IHD: 1/2 dose [B] PD: No data [D] CRRT: Dose for GFR 10-50 [D] |
Colchicine | 5-17 | Acute: 2 mg then 0.5 mg q6h Chronic: 0.5-1 mg q24h | 100% [B] | 50%-100% [B] | 25% [B] | IHD: None [D] PD: Dose for GFR < 10 [D] CRRT: Dose for GFR 10-50 [D] |
Diclofenac | < 1 | 25-75 mg bid | 50%-100% [D] | 25%-50% [D] | 25% [D] | IHD: None [D] PD: None [D] CRRT: Not applicable |
Ibuprofen | 1 | 800 mg tid | 100% [A] | 100% [A] | 100% [B] | IHD: None [D] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Indomethacin | 30 | 25-50 mg tid | 100% [A] | 100% [A] | 100% [A] | IHD: None PD: None [D] CRRT: Not applicable |
Ketorolac | 30-60 | 30-60 mg load, then 15-30 mg q6h | 100% [D] | 50% [B] | 25%-50% [B] | IHD: None [D] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Naproxen | < 1 | 500 mg bid | 100% [A] | 100% [A] | 100% [A] | IHD: None [D] PD: None [D] CRRT: Not applicable |
Bronchodilators | | | | | | |
Albuterol | 28 | 2 inhalations q4-6h | 100% [D] | 100% [D] | 100% [D] | IHD: None [D] PD: None [D] CRRT: 100% [D] |
Ipratropium | No data | 2 inhalations qid | 100% [D] | 100% [D] | 100% [D] | IHD: None [D] PD: None [D] CRRT: 100% [D] |
Salmeterol | < 1 | 1-2 inhalations bid | 100% [D] | 100% [D] | 100% [D] | IHD: None [D] PD: None [D] CRRT: 100% [D] |
Theophylline | < 10 | 6 mg/kg load, then 9 mg/kg q24h | 100% [A] | 100% [A] | 100% [A] | IHD: 125% during dialysis [B] PD: None [D] CRRT: 100% [D] |
Corticosteroids | | | | | | |
Dexamethasone | 8 | 0.75-9 mg q24h | 100% [D] | 100% [D] | 100% [D] | IHD: None [D] PD: None [D] CRRT: 100% [D] |
Hydrocortisone | None | 20-500 mg q24h | 100% [A] | 100% [A] | 100% [A] | IHD: None [D] PD: None [D] CRRT: 100% [D] |
Methylprednisolone | < 10 | 4-48 mg q24h | 100% [A] | 100% [A] | 100% [A] | IHD: Yes [D] PD: None [D] CRRT: 100% [D] |
Prednisone | 34 | 5-60 mg q24h | 100% [A] | 100% [A] | 100% [A] | IHD: Yes [B] PD: None [B] CRRT: 100% [D] |
Hypoglycemic Agents | | | | | | |
Glipizide | 4.5-7 | 2.5-15 mg q24h | 100% [B] | 50% [B] | 50% [B] | IHD: None [D] PD: Dose for GFR < 10 [D] CRRT: Not applicable |
Glyburide | 50 | 1.25-20 mg q24h | No data | No data | 100% [A] | IHD: None PD: None CRRT: Not applicable |
Metformin | 90-100 | 500-850 mg bid | 50% [B] | 25% [B] | Avoid [B] | IHD: Not applicable [D] PD: None [D] CRRT: Not applicable |
Glipizide | 4.5-7 | 2.5-15 mg q24h | 100% [B] | 50% [B] | 50% [B] | IHD: None [D] PD: Dose for GFR < 10 [D] CRRT: Not applicable |
Insulin | None | Variable | 100% [A] | 75% [A] | 50% [A] | IHD: None [A] PD: None [A] CRRT: Dose for GFR 10-50 |
Hypolipidemic Agents | | | | | | |
Cholestyramine | None | 4 g q4-6h | 100% [D] | 100% [D] | 100% [D] | IHD: None [D] PD: None [D] CRRT: 100%[D] |
Gemfibrozil | None | 600 mg bid | 100% [B] | 75% [B] | 50% [B] | IHD: None [D] PD: Dose for GFR < 10 [D] CRRT: Not applicable |
Nicotinic acid | None | 1-2 g tid | 100% [B] | 50% [B] | 25% [B] | IHD: None [D] PD: Doses for GFR < 10 [D] CRRT: Dose for GFR 10-50 [D] |
Pravastatin | < 10 | 10-40 mg q24 | 100% [A] | 100% [A] | 100% [A] | IHD: None [B] PD: None [B] CRRT: Dose for GFR 10-50 [D] |
Simvastatin | < 0.5 | 5-40 mg q24h | 100% [A] | 100% [A] | 100% [A] | IHD: None [D] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Miscellaneous Drugs | | | | | | |
Metoclopramide | 10-22 | 10-15 mg qid | 100% [A] | 75% [A] | 50% [A] | IHD: None [D] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Ondansetron | < 5 | 8-10 mg IV q6-12h | 100% [A] | 100% [A] | 100% [A] | IHD: None [B] PD: None [B] CRRT: Dose for GFR 10-50 [D] |
Neuromuscular Agents | | | | | | |
Atracurium | None | 0.4-0.5 mg/kg load, then 0.08-0.1 mg/kg q15-25 min | 100% [D] | 100% [D] | 100% [D] | IHD: Not applicable [D] PD: Not applicable [D] CRRT: Dose for GFR 10-50 [B] |
Etomidate | 2 | 0.2-0.6 mg/kg | 100% [D] | 100% [D] | 100% [D] | IHD: Not applicable [D] PD: Not applicable [D] CRRT: Dose for GFR 10-50 [D] |
Fentanyl | 6-8 | 0.002-0.05 mg/kg | 100% [D] | 100% [D] | 100% [D] | IHD: None [D] PD: None [D] CRRT: Dose for GFR 10-50 [B] |
Ketamine | 2-3 | 1-4.5 mg/kg | 100% [D] | 100% [D] | 100% [D] | IHD: Not applicable [D] PD: Not applicable [D] CRRT: Dose for GFR 10-50 [B] |
Pancuronium | 30-40 | 0.04-0.1 mg/kg | 100% [A] | 50% [B] | Avoid [B] | IHD: Avoid [D] PD: Avoid [D] CRRT: Dose for GFR 10-50 [D] |
Propofol | < 0.3 | 2-2.5 mg/kg | 100% [B] | 100% [B] | 100% [B] | IHD: None [D] PD: None [D] CRRT: Dose for GFR 10-50 [B] |
Succinylcholine | None | 0.3-1.1 mg/kg load, then 0.04-0.07 mg/kg prn | 100% [A] | 100% [A] | 100% [A] | IHD: Not applicable [D] PD: Dose for GFR < 10 [D] CRRT: Dose for GFR 10-50 [D] |
Vecuronium | 25 | 0.08-0.1 mg/kg load, then 0.01-0.05 mg/kg q12-15 min | 100% [A] | 100% [A] | 100% [A] | IHD: Not applicable [D] PD: Not applicable [D] CRRT: Dose for GFR 10-50 [D] |
Proton-Pump Inhibitors | | | | | | |
Lansoprazole | None | 15-60 mg q24h | 100% [A] | 100% [A] | 100% [A] | IHD: None [D] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Omeprazole | Negligible | 20-60 mg q24h | 100% [A] | 100% [A] | 100% [A] | IHD: None [B] PD: None [B] CRRT: Dose for GFR 10-50 [D] |
Antidepressants | | | | | | |
Bupropion | Hepatic | 100 mg q8 | 100% [D] | 100% [D] | 100% [D] | IHD: No data [D] PD: Dose for GFR < 10 [D] CRRT: Dose for GFR 10-50 [D] |
Trazodone | 10-20 (renal) | 150-400 mg q24h | 100% [A] | 100% [B] | 100% [B] | IHD: None [D] PD: None [D] CRRT: 100% [D] |
Venlafaxine | Hepatic | 75-375 mg q24h | 75% [B] | 50% [B] | 50% [B] | IHD: None [D] PD: None [D] CRRT: 100% [D] |
Barbiturates | | | | | | |
Pentobarbital | Hepatic | 30 mg q6-8h | 100% [A] | 100% [A] | 100% [A] | IHD: None [B] PD: None [B] CRRT: Dose for GFR 10-50 [B] |
Benzodiazepines | | | | | | |
Lorazepam | Hepatic | 1-2 mg q8-12h | 100% [A] | 100% [A] | 100% [A] | IHD: None [B] PD: None [D] CRRT: Dose for GFR 10-50 [B] |
Midazolam | Hepatic | Individualized | 100% [A] | 100% [A] | 50% [A] | IHD: Not applicable [D] PD: Not applicable [D] CRRT: Dose for GFR 10-50 [A] |
Miscellaneous Sedative Agents | | | | | | |
Buspirone | Hepatic | 5 mg q8h | 100% [D] | 100% [D] | 100% [D] | IHD: None [B] PD: Dose for GFR < 10 [D] CRRT: Dose for GFR 10-50 [B] |
Haloperidol | Hepatic | 1-2 mg q8-12h | 100% [D] | 100% [D] | 100% [D] | IHD: None [D] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Lithium carbonate | Renal | 0.9-1.2 g q24h | 100% [A] | 50%-75% [A] | 25%-50% [A] | IHD: Dose after dialysis [B] PD: None [D] CRRT: Dose for GFR 10-50 [A] |
Antipyschotic Agents | | | | | | |
Chlorpromazine | Hepatic | 300-800 mg q24h | 100% [D] | 100% [D] | 100% [D] | IHD: None [D] PD: Dose for GFR < 10 [D] CRRT: Dose for GFR 10-50 [D] |
Promethazine | Hepatic | 20-100 mg q24h | 100% [D] | 100% [D] | 100% [D] | IHD: None [D] PD: None [D] CRRT: Not applicable [D] |
Selective Serotonin Reuptake Inhibitors (SSRIs) | | | | | | |
Fluoxetine | Hepatic | 20 mg q24h | 100% [D] | 100% [D] | 100% [D] | IHD: None [D] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Paroxetine | Hepatic | 20-60 mg q24h | 100% [A] | 50%-75% [B] | 50% [B] | IHD: None [D] PD: Dose for GFR < 10 [D] CRRT: Dose for GFR 10-50 [D] |
Sertraline | Hepatic | 50-200 mg q24h | 100% [A] | 100% [A] | 100% [A] | IHD: None [D] PD: None [D] CRRT: Dose for GFR 10-50 [D] |
Tricyclic Antidepressants | | | | | | |
Amitriptyline | Hepatic | 25 mg q8h | 100% [D] | 100% [D] | 100% [D] | IHD: None [D] PD: None [B] CRRT: Dose for GFR 10-50 [D] |
Clomipramine | Hepatic | 100-250 mg q24h | 100% [D] | 100% [D] | 100% [D] | IHD: None [D] PD: Dose for GFR < 10 [D] CRRT: Avoid [D] |
Desipramine | Hepatic | 100-250 mg q24h | 100% [D] | 100% [D] | 100% [D] | IHD: None [D] PD: dose for GFR < 10 [D] CRRT: Avoid [D] |
Imipramine | Hepatic | 25 mg q8 | 100% [A] | 100% [A] | 100% [A] | IHD: None [D] PD: None [A] CRRT: Dose for GFR 10-50 [D] |
Nortriptyline | Hepatic | 25 mg q6-8h | 100% [B] | 100% [B] | 100% [B] | IHD: None [D] PD: None [D] CRRT: Dose for GFR 10-50 [D] |