Drug Dosing Considerations in Continuous Renal Replacement Therapy

Nowadays, in critically ill patients with acute kidney injury (AKI), drug dosing regimens are derived from studies on healthy volunteers or patients with chronic kidney disease. In this chapter, we summarize pharmacokinetic/pharmacodynamic relationship changes due to the typical homeostatic disturbance or altered end-organ function in critical illnesses. Then we focus on how renal clearance alterations and continuous renal replacement therapy (CRRT) may affect the dosage and dosing interval of drugs. Finally, practical tips have been suggested to prescribe the ‘right’ dose in critically ill patients needing CRRT. Effectively, a change in basic assumptions from a ‘drug-centred’ approach to a ‘patient-centred’ approach could be useful and manageable, especially in settings where therapeutic drug monitoring is unavailable.