title: Milrinone Dosing Issues in Critically Ill Children With Kidney Injury: A Review.
abstract: Milrinone is an inotropic drug used in a variety of clinical settings in adults and children. The efficacy of milrinone in pediatric low-cardiac output syndrome after cardiac surgery is reported. Its primary route of removal from the body is through the kidney as unchanged drug in the urine. Milrinone is not known to be efficiently removed by extracorporeal dialytic therapies and thus has the potential to cause serious adverse effects and potentially worsens renal function in patients experiencing acute kidney injury (AKI). AKI is an important public health issue that is associated with increased morbidity, mortality, and cost. It is a known risk factor for the development of chronic kidney disease. There are no specific therapies to mitigate AKI once it has developed, and interventions are focused on supportive care and dose adjustment of medications. Estimating glomerular filtration rate based on height and serum creatinine is the most commonly used clinical method for assessing kidney function and modification of medication doses. The purpose of this review is to discuss our current understanding of milrinone pharmacokinetics and pharmacodynamics in children with AKI and to describe the potential use of urinary biomarkers to guide therapeutic decision making for milrinone dosing.
authors.affiliation: *Department of Pediatrics, University of Colorado, Children's Hospital Colorado, The Heart Institute, Aurora, CO; †Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Center for Acute Care Nephrology, Cincinnati, OH; ‡Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO; and §Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Katja M
authors.initials: KM
authors.lastname: Gist
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldstein
authors.forename: Melanie S
authors.initials: MS
authors.lastname: Joy
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Vinks
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000378:metabolism; D002648:Child; D016638:Critical Illness / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D008657:Metabolic Clearance Rate / Q000187:drug effects / Q000502:physiology; D020105:Milrinone / Q000008:administration & dosage* / Q000493:pharmacokinetics; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000493:pharmacokinetics
chemical_list: D014665:Vasodilator Agents; D020105:Milrinone