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Acute Nephrology for the Critical Care Physician pp 233–243Cite as

Drug Removal by CRRT and Drug Dosing in Patients on CRRT

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Abstract

Correct drug dosing is of utmost importance for therapeutic success in critically ill patients. This especially applies to sepsis where early adequate dosing of antibiotics may be lifesaving. Correct drug dosing should take into account the major alterations in pharmacokinetics induced by critical illness and the drug’s pharmacokinetic/pharmacodynamic relationship. The addition of continuous renal replacement therapy (CRRT) adds another factor of uncertainty. The main factors affecting extracorporeal drug removal include effluent flow rate, protein binding and volume of distribution. Especially for hydrophilic drugs with small distribution volume and mainly renal elimination, the extracorporeal treatment will contribute significantly to the total body clearance and thus require dosage adaptation. The important and dynamic pharmacokinetic alterations induced by the underlying illness and the variability in CRRT treatments preclude a “one size fits all” approach. Therapeutic drug monitoring (TDM) is the only reliable method to guide dosing in these complex patients. If TDM is not available, understanding the drug’s pharmacokinetic profile and the characteristics of the CRRT treatment are most helpful.

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Author information

Authors and Affiliations

  1. Clinical Division of Intensive Care Medicine, Department of Cellular and Molecular Medicine, University of Leuven, Leuven, 3000, Belgium

    Miet Schetz MD, PhD

  2. Service d’Anesthésie-Réanimation, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, 33000, France

    Olivier Joannes-Boyau MD

  3. Department of Intensive Care, Academic Medical Center, University of Amsterdam, 22660, Amsterdam, 1100 DD, The Netherlands

    Catherine Bouman MD, PhD

Authors
  1. Miet Schetz MD, PhD
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  2. Olivier Joannes-Boyau MD
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  3. Catherine Bouman MD, PhD
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Corresponding author

Correspondence to Miet Schetz MD, PhD .

Editor information

Editors and Affiliations

  1. Department of Intensive Care, VU University Hospital, Amsterdam, The Netherlands

    Heleen M. Oudemans-van Straaten

  2. Department of Intensive Care Medicine, Anaesthesia Critical Care Collaborative, Research Group (SPACeR) and Faculty of Health Care Sciences, Royal Surrey County Hospital NHS, Foundation Trust, Surrey Perioperative, University of Surrey, Guildford, United Kingdom

    Lui G. Forni

  3. Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands

    A.B. Johan Groeneveld

  4. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada

    Sean M. Bagshaw

  5. Division of Intensive Care and Emergency Medicine, Department of General Internal Medicine, Medical University Innsbruck, Anichstrasse, Innsbruck, Austria

    Michael Joannidis

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Schetz, M., Joannes-Boyau, O., Bouman, C. (2015). Drug Removal by CRRT and Drug Dosing in Patients on CRRT. In: Oudemans-van Straaten, H., Forni, L., Groeneveld, A., Bagshaw, S., Joannidis, M. (eds) Acute Nephrology for the Critical Care Physician. Springer, Cham. https://doi.org/10.1007/978-3-319-17389-4_18

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  • DOI: https://doi.org/10.1007/978-3-319-17389-4_18

  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-17389-4

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