title: Effect of Kidney Function on Drug Kinetics and Dosing in Neonates, Infants, and Children.
abstract: Neonates, infants, and children differ from adults in many aspects, not just in age, weight, and body composition. Growth, maturation and environmental factors affect drug kinetics, response and dosing in pediatric patients. Almost 80% of drugs have not been studied in children, and dosing of these drugs is derived from adult doses by adjusting for body weight/size. As developmental and maturational changes are complex processes, such simplified methods may result in subtherapeutic effects or adverse events. Kidney function is impaired during the first 2 years of life as a result of normal growth and development. Reduced kidney function during childhood has an impact not only on renal clearance but also on absorption, distribution, metabolism and nonrenal clearance of drugs. 'Omics'-based technologies, such as proteomics and metabolomics, can be leveraged to uncover novel markers for kidney function during normal development, acute kidney injury, and chronic diseases. Pharmacometric modeling and simulation can be applied to simplify the design of pediatric investigations, characterize the effects of kidney function on drug exposure and response, and fine-tune dosing in pediatric patients, especially in those with impaired kidney function. One case study of amikacin dosing in neonates with reduced kidney function is presented. Collaborative efforts between clinicians and scientists in academia, industry, and regulatory agencies are required to evaluate new renal biomarkers, collect and share prospective pharmacokinetic, genetic and clinical data, build integrated pharmacometric models for key drugs, optimize and standardize dosing strategies, develop bedside decision tools, and enhance labels of drugs utilized in neonates, infants, and children.
authors.affiliation: Department of Pediatric Clinical Pharmacology, Pediatric Pharmacology and Pharmacometrics Research Center, University Children's Hospital (UKBB), University of Basel, Spitalstrasse 33, CH-4056, Basel, Switzerland. Frederique.Rodieux@ukbb.ch.
authors.forename: Frederique
authors.initials: F
authors.lastname: Rodieux
authors.affiliation: Department of Pediatric Clinical Pharmacology, Pediatric Pharmacology and Pharmacometrics Research Center, University Children's Hospital (UKBB), University of Basel, Spitalstrasse 33, CH-4056, Basel, Switzerland.
authors.forename: Melanie
authors.initials: M
authors.lastname: Wilbaux
authors.affiliation: Department of Pediatric Clinical Pharmacology, Pediatric Pharmacology and Pharmacometrics Research Center, University Children's Hospital (UKBB), University of Basel, Spitalstrasse 33, CH-4056, Basel, Switzerland. JVandena@cnmc.org.|Division of Pediatric Clinical Pharmacology, Children's National Health System, Washington, DC, USA. JVandena@cnmc.org.|Intensive Care, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands. JVandena@cnmc.org.
authors.forename: Johannes N
authors.initials: JN
authors.lastname: van den Anker
authors.affiliation: Department of Pediatric Clinical Pharmacology, Pediatric Pharmacology and Pharmacometrics Research Center, University Children's Hospital (UKBB), University of Basel, Spitalstrasse 33, CH-4056, Basel, Switzerland.|Quantitative Solutions LP, Menlo Park, CA, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Pfister
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy / Q000378:metabolism; D000583:Amikacin / Q000493:pharmacokinetics*; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics*; D015415:Biomarkers / Q000378:metabolism; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000502:physiology*; D008954:Models, Biological; D010599:Pharmacokinetics; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D000583:Amikacin