title: Considerations for Medication Management and Anticoagulation During Continuous Renal Replacement Therapy.
abstract: Providing safe and high-quality care to critically ill patients receiving continuous renal replacement therapy (CRRT) includes adequate drug dosing and evaluation of patients' response to medications during therapy. Pharmacokinetic drug studies in acute kidney injury and CRRT are limited, considering the number of medications used in critical care. Therefore, it is important to understand the basic principles of drug clearance during CRRT by evaluating drug properties, CRRT modalities, and how they affect medication clearance. Few published studies have addressed drug disposition and clinical response during CRRT. Additionally, clotting in the CRRT circuit is a concern, so a few options for anticoagulation strategies are presented. This article reviews (1) the CRRT system and drug property factors that affect medication management, (2) the evidence available to guide drug dosing, and (3) anticoagulation strategies for critically ill patients receiving CRRT.
authors.affiliation: Ashley Thompson is Critical Care Pharmacist, Senior Pharmacist Supervisor, University of California, San Francisco (UCSF) Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, 533 Parnassus Ave. Box 0622, San Francisco, CA 94143 (ashley.thompson@ucsf.edu). Fanny Li is Critical Care Pharmacist, UCSF Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, San Fran-cisco, California. A. Kendall Gross is Critical Care Pharmacist, UCSF Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, California.
authors.forename: Ashley
authors.initials: A
authors.lastname: Thompson
authors.affiliation: Ashley Thompson is Critical Care Pharmacist, Senior Pharmacist Supervisor, University of California, San Francisco (UCSF) Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, 533 Parnassus Ave. Box 0622, San Francisco, CA 94143 (ashley.thompson@ucsf.edu). Fanny Li is Critical Care Pharmacist, UCSF Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, San Fran-cisco, California. A. Kendall Gross is Critical Care Pharmacist, UCSF Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, California.
authors.forename: Fanny
authors.initials: F
authors.lastname: Li
authors.affiliation: Ashley Thompson is Critical Care Pharmacist, Senior Pharmacist Supervisor, University of California, San Francisco (UCSF) Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, 533 Parnassus Ave. Box 0622, San Francisco, CA 94143 (ashley.thompson@ucsf.edu). Fanny Li is Critical Care Pharmacist, UCSF Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, San Fran-cisco, California. A. Kendall Gross is Critical Care Pharmacist, UCSF Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, California.
authors.forename: A Kendall
authors.initials: AK
authors.lastname: Gross
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation / Q000187:drug effects*; D003422:Critical Care / Q000592:standards*; D016638:Critical Illness / Q000628:therapy; D005260:Female; D005440:Fluid Therapy / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D017582:Renal Replacement Therapy / Q000592:standards*
keywords: CRRT; continuous renal replacement therapy; drug clearance; medication dosing; pharmacokinetics