title: Pharmacokinetics and pharmacodynamics of antibiotics in critically ill acute kidney injury patients.
abstract: Sepsis is the most common cause of death in critically ill patients and is associated with multiorgan failure, including acute kidney injury (AKI). This situation can require acute renal support and increase mortality. Therefore, it is essential to administer antimicrobials in doses that achieve adequate serum levels, avoiding both overdosing and drug toxicity as well as underdosing and the risk of antibiotic resistance and higher mortality. Currently, there are no validated guidelines on antibiotic dose adjustments in septic patients with AKI. The current recommendations were extrapolated from studies conducted in noncritical patients with end-stage chronic kidney disease receiving chronic renal replacement therapy. This study aimed to review and discuss the complexity of this issue, considering several factors related to drug metabolism, the characteristics of critically ill patients, the properties of antimicrobial drugs and dialysis methods.
authors.affiliation: Nephrology University São Paulo State-UNESP Botucatu SP 18618-970 Brazil.
authors.forename: Welder
authors.identifier: 0000-0003-2756-6621
authors.initials: W
authors.lastname: Zamoner
authors.affiliation: Nephrology University São Paulo State-UNESP Botucatu SP 18618-970 Brazil.
authors.forename: Fernanda M
authors.initials: FM
authors.lastname: de Freitas
authors.affiliation: Nephrology University São Paulo State-UNESP Botucatu SP 18618-970 Brazil.
authors.forename: Durval S S
authors.initials: DS
authors.lastname: Garms
authors.affiliation: Nephrology University São Paulo State-UNESP Botucatu SP 18618-970 Brazil.
authors.forename: Mariele Gobo
authors.initials: MG
authors.lastname: de Oliveira
authors.affiliation: Nephrology University São Paulo State-UNESP Botucatu SP 18618-970 Brazil.
authors.forename: André L
authors.initials: AL
authors.lastname: Balbi
authors.affiliation: Nephrology University São Paulo State-UNESP Botucatu SP 18618-970 Brazil.
authors.forename: Daniela
authors.initials: D
authors.lastname: Ponce
keywords: Acute kidney injury; antibiotics; critically ill patients; dialysis; drug toxicity; sepsis