Considerations for Medication Management and Anticoagulation During Continuous Renal Replacement Therapy

AACN Adv Crit Care. 2017 Spring;28(1):51-63. doi: 10.4037/aacnacc2017386.

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.

Keywords: CRRT; continuous renal replacement therapy; drug clearance; medication dosing; pharmacokinetics.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Coagulation / drug effects*
  • Critical Care / standards*
  • Critical Illness / therapy
  • Female
  • Fluid Therapy / standards*
  • Humans
  • Male
  • Middle Aged
  • Patient Safety / standards*
  • Quality of Health Care / standards*
  • Renal Insufficiency, Chronic / therapy*
  • Renal Replacement Therapy / standards*