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Drug Dosing in Acute Kidney Injury

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Core Concepts in Acute Kidney Injury

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Abstract

It is clear that alterations in renal function will alter medication excretion. However, the type of renal dysfunction may affect other parameters of drug handling. Chronic kidney disease (CKD) influences drug disposition through changes in several pharmacokinetic characteristics. Common pharmacokinetic abnormalities seen in patients with CKD include reduced oral absorption and glomerular filtration, altered tubular secretion and reabsorption, and changes in intestinal and hepatic clearance. Conversely, patients with acute kidney injury (AKI) without preexisting renal dysfunction may handle drugs differently than those patients with CKD or end-stage renal disease. Thus, dosing stratagems extrapolated from patients with CKD may result in subtherapeutic drug concentrations and ineffective treatment. Achieving a balance between under- and overdosing requires rigorous monitoring and individualized dosing. Several published reviews have discussed in great detail drug dosing strategies in CKD and/or patients with AKI receiving renal replacement therapies. This review will focus on key concepts surrounding the dosing of medications in patients with AKI not receiving renal replacement therapies.

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Authors and Affiliations

  1. Pharmacy Department, Brigham and Women’s Hospital, Boston, MA, USA

    Jeremy R. DeGrado

  2. Department of Pharmacy Services, Brigham and Women’s Hospital, Boston, MA, USA

    James F. Gilmore, Benjamin Hohlfelder & Craig A. Stevens

  3. Department of Transplant Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Steven Gabardi

  4. Department of Pharmacy Services/Renal Division, Brigham and Women’s Hospital, Boston, MA, USA

    Steven Gabardi

  5. Harvard Medical School, Boston, MA, USA

    Steven Gabardi

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  1. Jeremy R. DeGrado
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  2. James F. Gilmore
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  3. Benjamin Hohlfelder
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  4. Craig A. Stevens
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  5. Steven Gabardi
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Correspondence to Steven Gabardi .

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Editors and Affiliations

  1. Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Sushrut S. Waikar

  2. University College Dublin, Dublin, Ireland

    Patrick T. Murray

  3. Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Ajay K. Singh

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DeGrado, J.R., Gilmore, J.F., Hohlfelder, B., Stevens, C.A., Gabardi, S. (2018). Drug Dosing in Acute Kidney Injury. In: Waikar, S., Murray, P., Singh, A. (eds) Core Concepts in Acute Kidney Injury. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-8628-6_23

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