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Dose adjusted in crrt

Claire Roger, Steven C Wallis, Laurent Muller, Gilbert Saissi, Jeffrey Lipman, Roger J Brüggemann, Jean-Yves Lefrant, Jason A Roberts
BACKGROUND AND OBJECTIVE: Sepsis and continuous renal replacement therapy (CRRT) can both significantly affect antifungal pharmacokinetics. This study aimed to describe the pharmacokinetics of caspofungin in critically ill patients during different CRRT modes. METHODS: Patients receiving caspofungin and undergoing continuous veno-venous haemofiltration (CVVH) or haemodiafiltration (CVVHDF) were eligible to take part in the study. Blood samples were collected at seven sampling times during a dosing interval...
December 29, 2016: Clinical Pharmacokinetics
Lenar Yessayan, Jerry Yee, Stan Frinak, Balazs Szamosfalvi
Continuous renal replacement therapy (CRRT) is used to manage electrolyte and acid-base imbalances in critically ill patients with acute kidney injury. Although a standard solution and prescription is acceptable in most clinical circumstances, specific disorders may require a tailored approach such as adjusting fluid composition, regulating CRRT dose, and using separate intravenous infusions to mitigate and correct these disturbances. Errors in fluid prescription, compounding, or delivery can be rapidly fatal...
May 2016: Advances in Chronic Kidney Disease
David Gutierrez-Bernays, Matthew Ostwald, Chris Anstey, Victoria Campbell
Regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) has recently been recommended as first-line over heparin. Evidence suggests that RCA prolongs filter life and may reduce bleeding risk, but there is little research on the benefits to dialysis dose delivery or cost, or the effectiveness of transitioning to RCA first-line. The aim of the present study was to assess the effect on dialysis delivery, cost and safety when transitioning from systemic heparin to RCA for first-line anticoagulation for CRRT...
February 2016: Therapeutic Apheresis and Dialysis
Farahnak Assadi, Fatemeh Ghane Shahrbaf
The dosage of drugs in patients requiring continuous renal replacement therapy need to be adjusted based on a number of variables that that affect pharmacokinetics (PK) including patient weight, CRRT modality (convention, vs. diffusion), blood and/or effluent flow, hemofilter characteristics, physiochemical drug properties, volume of distribution, protein binding and half-life as well as residual renal function. There is a paucity of data on PK studies in children with acute kidney injury requiring CRRT. When possible, therapeutic drug monitoring should be utilized for those medications where serum drug concentrations can be obtained in a clinically relevant time frame...
2016: Frontiers in Bioscience (Scholar Edition)
Megan E Kunka, Elizabeth A Cady, Heejung C Woo, Melissa L Thompson Bastin
Purpose. A case report evaluating flucytosine dosing in a critically ill patient receiving continuous renal replacement therapy. Summary. This case report outlines an 81-year-old male who was receiving continuous venovenous hemofiltration (CVVH) for acute renal failure and was being treated with flucytosine for the treatment of disseminated Cryptococcus neoformans infection. Due to patient specific factors, flucytosine was empirically dose adjusted approximately 50% lower than intermittent hemodialysis (iHD) recommendations and approximately 33% lower than CRRT recommendations...
2015: Case Reports in Critical Care
Susan J Lewis, Lynn A Switaj, Bruce A Mueller
BACKGROUND/AIMS: To study transmembrane clearance (CLTM) and adsorption of tedizolid, a novel oxazolidinone antibiotic, in continuous hemofiltration (CVVH) and continuous hemodialysis (CVVHD). METHODS: In vitro CVVH/CVVHD models with polysulfone and AN69 hemodiafilters were used. Tedizolid CLTM during CVVH/CVVHD was assessed at various ultrafiltrate (Quf) and dialysate rates (Qd). Tedizolid adsorption was tested in a recirculating CVVH model over 4 h. RESULTS: In CVVH, CLTM did not differ between filter types...
2015: Blood Purification
Takanori Funaki, Ippei Miyata, Kensuke Shoji, Yuki Enomoto, Seisuke Sakamoto, Mureo Kasahara, Isao Miyairi
Optimal acyclovir dosing under continuous renal replacement therapy (CRRT) in neonates is unknown. We monitored serum acyclovir levels and herpes simplex virus 1 (HSV-1) DNA levels in a neonate with disseminated HSV-1 infection and renal failure undergoing CRRT. A full-term, 5-day-old female presented with a 2-day history of lethargy and fever. She developed fulminant hepatitis and was diagnosed with HSV-1 infection by real-time polymerase chain reaction. Acyclovir was initiated at 60 mg/kg/day, which was lowered to 20 mg/kg/day because of development of renal failure...
July 2015: Pediatrics
Bin Yu, Lixia Liu, Dong Xing, Congcong Zhao, Zhenjie Hu
OBJECTIVE: To investigate the extracorporeal clearance rate of imipenem in severe infection patients in the mode of continuous vena-venous hemofiltration (CVVH) during continuous renal replacement therapy (CRRT), in order to approach if the concentration of imipenem in plasma could achieve effective levels of anti-infection, and to explore the effect of time and anticoagulation measure on imipenem clearance during CRRT treatment. METHODS: A prospective observational study was conducted...
May 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Andrzej Wieczorek, Andrzej Tokarz, Wojciech Gaszynski, Tomasz Gaszynski
Doripenem is a novel wide-spectrum antibiotic, and a derivate of carbapenems. It is an ideal antibiotic for treatment of serious nosocomial infections and severe sepsis for its exceptionally high efficiency and broad antibacterial spectrum of action. Doripenem is eliminated mainly by the kidneys. In cases of acute kidney injury, dosing of doripenem depends on creatinine clearance and requires adjustments. Doripenem is eliminated during hemodialysis because its molecular weight is 300-400 Da. The aim of this study was to establish the impact of continuous renal replacement therapy (CRRT) slow low-efficiency dialysis (SLED) on doripenem serum concentrations in a population of intensive-therapy patients with life-threatening infections and severe sepsis...
2014: Drug Design, Development and Therapy
Marta Ulldemolins, Sergi Vaquer, Mireia Llauradó-Serra, Caridad Pontes, Gonzalo Calvo, Dolors Soy, Ignacio Martín-Loeches
Although early and appropriate antibiotic therapy remains the most important intervention for successful treatment of septic shock, data guiding optimization of beta-lactam prescription in critically ill patients prescribed with continuous renal replacement therapy (CRRT) are still limited. Being small hydrophilic molecules, beta-lactams are likely to be cleared by CRRT to a significant extent. As a result, additional variability may be introduced to the per se variable antibiotic concentrations in critically ill patients...
June 23, 2014: Critical Care: the Official Journal of the Critical Care Forum
Sai-Ping Jiang, Zheng-Yi Zhu, Xiao-Liang Wu, Xiao-Yang Lu, Xing-Guo Zhang, Bao-Hua Wu
BACKGROUND: The impact of continuous renal replacement therapy (CRRT) on drug removal is complicated; pharmacist dosing adjustment for these patients may be advantageous. This study aims to describe the development and implementation of pharmacist dosing adjustment for critically ill patients receiving CRRT and to examine the effectiveness of pharmacist interventions. METHODS: A comparative study was conducted in an intensive care unit (ICU) of a university-affiliated hospital...
2014: Therapeutics and Clinical Risk Management
Alexander H Flannery, Melissa L Thompson Bastin
OBJECTIVE: To evaluate the literature for published reports regarding the efficacy of standard versus higher dosing of oseltamivir in critically ill patients with severe influenza. DATA SOURCES: An English-language literature search was conducted using MEDLINE (1966-February 2014) using the terms oseltamivir and influenza limited to humans and adults older than 19 years. Additional articles were identified through a manual search of the references obtained from the MEDLINE search...
August 2014: Annals of Pharmacotherapy
Jean-Michel Liet, Emma Allain-Launay, Bénédicte Gaillard-LeRoux, François Barrière, Alexis Chenouard, Jean-Marc Dejode, Nicolas Joram
BACKGROUND: In continuous renal replacement therapy (CRRT), regional citrate anticoagulation offers an attractive alternative to heparinization, especially for children with a high bleeding risk. METHODS: We report on a new management approach to CRRT using integrated citrate software and physiological sodium concentration solutions. Convective filtration was performed with pre-filter citrate anticoagulation using an 18 mmol/L citrate solution and a post-filter replacement fluid...
September 2014: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Gerardo Aguilar, José Ramón Azanza, José A Carbonell, Carlos Ferrando, Rafael Badenes, María Asunción Parra, Belén Sadaba, David Navarro, Jaume Puig, Amanda Miñana, Carlos Garcia-Marquez, Gergana Gencheva, Andrea Gutierrez, Francisco J Marti, F Javier Belda
BACKGROUND: Anidulafungin is indicated as a first-line treatment for invasive candidiasis in critically ill patients. In the intensive care unit, sepsis is the main cause of acute renal failure, and treatment with continuous renal replacement therapy (CRRT) has increased in recent years. Antimicrobial pharmacokinetics is affected by CRRT, but few studies have addressed the optimal dosage for anidulafungin during CRRT. PATIENTS AND METHODS: We included 12 critically ill patients who received continuous venovenous haemodiafiltration to treat acute renal failure...
June 2014: Journal of Antimicrobial Chemotherapy
Sai-Ping Jiang, Zheng-Yi Zhu, Kui-Fen Ma, Xia Zheng, Xiao-Yang Lu
BACKGROUND: Correct dosing of antimicrobial drugs in septic patients receiving continuous renal replacement therapy (CRRT) is complex. This study aimed to evaluate the effects of dosing adjustments performed by pharmacists on the length of intensive care unit (ICU) stay, ICU cost, and antimicrobial adverse drug events (ADEs). METHODS: A single-center, 2-phase (pre-/post-intervention) study was performed in an ICU of a university-affiliated hospital. Septic patients receiving CRRT in the post-intervention phase received a specialized antimicrobial dosing service from critical care pharmacists, whereas patients in the pre-intervention phase received routine medical care without involving pharmacists...
December 2013: Scandinavian Journal of Infectious Diseases
Samuel M Galvagno, Caron M Hong, Matthew E Lissauer, Andrew K Baker, Sarah B Murthi, Daniel L Herr, Deborah M Stein
Familiarity with the initiation, dosing, adjustment, and termination of continuous renal replacement therapy (CRRT) is a core skill for contemporary intensivists. Guidelines for how to administer CRRT in the intensive care unit are not well documented. The purpose of this review is to discuss the modalities, terminology, and components of CRRT, with an emphasis on the practical aspects of dosing, adjustments, and termination. Management of electrolyte and acid-base derangements commonly encountered with acute renal failure is emphasized...
December 2013: Journal of Critical Care
Alexandre Boyer, Didier Gruson, Stéphane Bouchet, Benjamin Clouzeau, Bui Hoang-Nam, Frédéric Vargas, Hilbert Gilles, Mathieu Molimard, Anne-Marie Rogues, Nicholas Moore
Aminoglycoside nephrotoxicity has been reported in patients with sepsis, and several risk factors have been described. Once-daily dosing and shorter treatment have reduced nephrotoxicity risk, and simplified aminoglycoside monitoring. This review focuses on nephrotoxicity associated with aminoglycosides in the subset of patients with septic shock or severe sepsis. These patients are radically different from those with less severe sepsis. They may have, for instance, renal impairment due to the shock per se, sepsis-related acute kidney injury, frequent association with pre-existing risk factors for renal failure such as diabetes, dehydration and other nephrotoxic treatments...
April 2013: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
Natalia de la Llama-Celis, Rafael Huarte-Lacunza, Cristina Gómez-Baraza, Iciar Cañamares-Orbis, Manuel Sebastián-Aldeanueva, Raquel Arrieta-Navarro
The echinocandins have a growing role in the treatment of fungal infections because of their novel mechanism of action. This is reflected in recently published management guidelines, but available in vitro data, animal studies, and clinical studies do not clearly differentiate the three agents in class. Comparative clinical efficacy among agents within the class, pharmacokinetic profiles in special populations, pharmacoeconomics justifications, and place in therapy have been largely unanswered. They share many common properties but marketing strategies of drug manufacturers are engaged in product differentiation...
December 2012: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
Heleen M Oudemans-van Straaten, Marlies Ostermann
To prevent clotting in the extracorporeal circuit during continuous renal replacement therapy (CRRT) anticoagulation is required. Heparin is still the most commonly used anticoagulant. However, heparins increase the risk of bleeding, especially in critically ill patients. Evidence has accumulated that regional anticoagulation of the CRRT circuit with citrate is feasible and safe. Compared to heparin, citrate anticoagulation reduces the risk of bleeding and requirement for blood products, not only in patients with coagulopathy, but also in those without...
December 7, 2012: Critical Care: the Official Journal of the Critical Care Forum
Nadezda Petejova, Arnost Martinek, Jana Zahalkova, Jana Duricova, Hana Brozmannova, Karel Urbanek, Milan Grundmann, Jiri Plasek, Ivana Kacirova
AIMS: To assess the influence of continuous venovenous hemofiltration (CVVH) at a filtration rate of 45 mL/kg/h on vancomycin pharmacokinetics in critically ill septic patients with acute kidney injury (AKI). METHODS: Seventeen adult septic patients with acute kidney injury treated with CVVH and vancomycin were included. All patients received first dose of 1.0 g intravenously followed by 1.0 g/12 h if not adjusted. In sixteen patients vancomycin was introduced on the day of the start of CRRT therapy...
2014: Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia
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