RT Book, Section
A1 Makino, Jun
A1 Oropello, John M.
A2 Oropello, John M.
A2 Pastores, Stephen M.
A2 Kvetan, Vladimir
SR Print(0)
ID 1136420275
T1 Medication Dosing During Renal Replacement Therapy
T2 Critical Care
YR 1
FD 1
PB McGraw-Hill Education
PP New York, NY
SN 9780071820813
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1136420275
RD 2024/04/20
AB The  aim  of  drug  dosing  is  to  maintain  pharmacokinetics  (a  similar  peak,  trough,  or  average  steady-state  drug  concentration)  to  achieve  a  desired  pharmacodynamic  response  without  adverse  side  effects.1  In  critically  ill  patients  receiving  renal  replacement  therapy  (RRT),  however,  determining  appropriate  drug  dosing  is  challenging  because  pharmacodynamic  target  attainment  is  determined  by  a  complex  interplay  between  drug  dosing,  pharmacokinetic  changes  within  the  critically  ill  patient,  and  the  type  of  RRT  selected  (Table  112–1).2  A  stepwise  approach  for  patients  with  chronic  kidney  disease  and  acute  kidney  injury  has  been  proposed  (Table  112–2).3  For  assessment  of  kidney  function,  estimation  by  equation  is  generally  more  accurate  than  measured  creatinine  clearance,  given  errors  in  urine  collection.4  Therefore,  the  National  Kidney  Disease  Education  Program  in  the  United  States  recommends  estimation  of  the  glomerular  filtration  rate  from  the  Cockcroft  and  Gault  equation  for  adults:  urinary  creatinine  clearance  =  (140  –  age  [years])  ×  weight  (kg)  ×  0.85  (for  female)/serum  creatinine  (mg/dL)  ×  72  or  the  Schwartz  equation  for  children.5,6