title: Higher renal replacement therapy dose delivery influences on drug therapy.
abstract: Higher doses of renal replacement therapy have profound effects on pharmacotherapy, yet little research has been conducted in this area. High-volume renal replacement therapies influence both the pharmacokinetic and the pharmacodynamic profiles of all drugs administered to these critically ill patients. Intermittent high-dose "hybrid" hemodialysis therapies remove drugs to a much different degree than standard thrice-weekly hemodialysis, yet pharmacokinetic studies have not been performed in patients receiving these therapies. High-volume continuous renal replacement therapies offer dosing challenges not seen with standard low-dose therapies. This article describes the pharmacokinetic and pharmacodynamic issues presented by high-volume renal replacement therapies. Given the importance that pharmacotherapy has on optimal patient outcomes, a better understanding of the influence that high-volume renal replacement therapy has on drugs is essential if these high volume therapies are to be used successfully in the intensive care unit.
authors.affiliation: Clinical Sciences Department, College of Pharmacy, University of Michigan, Ann Arbor, MI 48109, USA. muellerb@umich.edu
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Mueller
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Pasko
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Sowinski
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000628:therapy*; D016638:Critical Illness; D004305:Dose-Response Relationship, Drug; D011307:Drug Prescriptions; D006801:Humans; D010599:Pharmacokinetics; D017582:Renal Replacement Therapy / Q000379:methods*