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The effect of renal failure on drug handling in critical illness 

The effect of renal failure on drug handling in critical illness
The effect of renal failure on drug handling in critical illness

Myrna Y. Munar

and Ali J. Olyaei

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date: 16 May 2022

The kidneys play an important role in the elimination of many drugs. In chronic kidney disease and acute kidney injury several pharmacokinetic processes are altered. Thus, patients with impaired renal function require adjustment of medication dosing. Many drugs require a loading dose to rapidly achieve therapeutic plasma concentrations. Subsequently, the dose or dosing interval may have to be adjusted as appropriate for the degree for renal function. The most common method to estimate renal function is use of the Cockcroft–Gault (CG) equation. It has been well validated, is easy to remember, and is fairly accurate in estimating kidney function. Most drugs are dosed based on the patient’s weight (mg/kg), which makes the CG method easier to use for most estimates. Other methods are available and a patient’s renal function should always be estimated based on the best available evidence for that specific patient. Patients with chronic kidney disease are at great risk of developing kidney injury from drugs or diagnostic agents. Exposure to nephrotoxins should be avoided as much as possible.

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