Drug Dosing during Acute Kidney Injury and Renal Replacement Therapy
Summary
Acute kidney injury (AKI) is a common in critically ill patients. It is characterized as a syndrome in which there is a sudden and rapid decline in kidney function, involving both structural damage and functional impairment (Kellum and Lameire 2013). AKI presents a range of causes and varying degrees of severity, ranging from acute kidney damage to acute kidney failure (Kellum and Lameire 2013). Acute kidney damage refers to the initial injury to the kidneys, while acute kidney failure is the severe stage where the kidneys can no longer filter waste or maintain fluid and electrolyte balance. Acute kidney injury also refers to a condition where the damage progresses to a measurable stage, classified as stages 1 to 3 (Table 1). Diagnosis of AKI relies on two key parameters: urine output as a clinical criterion and serum creatinine as a biomarker for kidney function (Mehta et al. 2007). The current recommended classification system for AKI in intensive care units (ICU) is the international Kidney Disease Improving Global Outcomes (KDIGO) classification (Table 1) (Khwaja 2012). Critically ill patients with AKI face a significantly high mortality rate, potentially reaching up to 60% (Uchino et al. 2005).
General Information
Enrolled trainees 69
Open 27.09.2024
Available for ESICM members
Student effort 3
Last Updated September 27, 2024
Intended Learning Outcomes
After studying this module on Drug dosing during acute kidney injury and renal replacement therapy , you should be able to:
- Understand the pathophysiology and diagnostic criteria of acute kidney injury (AKI) in critically ill patients, including the classification system according to the KDIGO criteria, to effectively recognize and assess AKI in clinical practice.
- Evaluate the impact of acute kidney injury on drug pharmacokinetics and pharmacodynamics, recognizing the challenges in dosing medications in critically ill patients with AKI, and develop strategies to optimize drug therapy.
- Analyse the principles of renal function assessment, including the estimation of renal clearance and the influence of renal replacement therapy (RRT) on drug dosing, to tailor dosing regimens for critically ill patients with AKI undergoing RRT.
- Apply dosing adjustment strategies, considering the dynamic nature of acute kidney injury and the variability in drug pharmacokinetics, incorporating principles of therapeutic drug monitoring (TDM) and dose optimization to ensure safe and effective drug therapy in critically ill patients.
Relevant competencies in CoBaTrICE
- 3.4 Recognises and manages the patient with, or at risk of, acute kidney injury
- 4.1 Prescribes drugs and therapies safely
- 4.2 Manages antimicrobial drug therapy
- 4.7 Initiates, manages and weans patients from renal replacement therapy
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