The Japanese Journal of Clinical Dialysis Vol.35 No.6(7)

Theme Evidence and issue for clinical practice of acute kidney injury
Title Alteration of pharmacokinetics and strategies of dosage setting during acute blood purification
Publish Date 2019/06
Author Takehito Yamamoto The Education Center for Clinical Pharmacy, Graduate School of Pharmaceutical Sciences, The University of Tokyo
[ Summary ] Generally, the pharmacokinetics of renally excreted drugs are altered during acute blood purification. Therefore, special consideration is needed for the dosage settings of drugs during acute blood purification such as continuous renal replacement therapy (CRRT) or sustained low-efficiency dialysis (SLED). The effluent flow rate (QE) of CRRT is the major determinant of its drug eliminating capacity, and the drug clearance by CRRT accounts for creatinine clearance (Ccr) or glomerular filtration rate (GFR) of 10-30 mL/min. Therefore, in most cases, dosage during CRRT is as same as those for patients with moderately impaired renal function (i.e. Ccr or GFR of 10-50 mL/min), while the dosage during SLED should be the same as during CRRT. However, the information regarding alteration of pharmacokinetics during SLED is limited and further studies are needed to enable the optimal dosage setting.
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