Drug dosage in continuous venovenous hemofiltration in critically ill children

Assadi, Farahnak; Shahrbaf, Fatemeh Ghane

doi:10.2741/s446

Cited by 3 publications

(2 citation statements)

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“…In a table of sieving coefficients of various drugs, Assadi and Shahrbaf [12] published a value of 0.7 for clonidine. Unfortunately, there was no reference to the source of this sieving coefficient and we do not know in which context it was determined.…”

Section: Discussionmentioning

confidence: 99%

In vivo Elimination of Clonidine by Continuous Venovenous Hemofiltration in Critically Ill Patients

et al. 2020

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Background: Clonidine is an α 2-agonist that is commonly used for sedation in the intensive care unit. When patients are on continuous venovenous hemofiltration (CVVH) in the presence of kidney dysfunction, the sieving coefficient of clonidine is required to estimate how much drug is removed by CVVH. In the present study, we measured the sieving coefficient of clonidine in critically ill, ventilated patients receiving CVVH. Methods: A total of 20 samples of plasma and ultrafiltrate of 3 patients on CVVH, using a standard 1.5 m 2 polyacrylonitrile AN69 membrane, during continuous clonidine infusion were collected. After correction for the effect of predilution, we calculated the sieving coefficient for clonidine. Results: The mean sieving coefficient of clonidine was 0.52 (SD 0.097). Conclusion: Using a polyacrylonitrile AN69 membrane in a CVVH machine, the in vivo sieving coefficient of clonidine was 0.52.

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Section: Discussionmentioning

confidence: 99%

In vivo Elimination of Clonidine by Continuous Venovenous Hemofiltration in Critically Ill Patients

et al. 2020

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“…The pharmacokinetics of these medicines is rarely described for pediatric patients with pre-existing kidney injury, AKI, CKD or KRT (continuous or intermittent KRT –CKRT, hemodialysis-HD, hemodiafiltration-HDF, continuous veno-venous hemodiafiltration-CVVHD, peritoneal dialysis-PD, etc.) and recommendations are needed, as anti-infective drugs, especially antibiotics, are among the most commonly prescribed drug classes in children ( 14 – 17 ).…”

Section: Introductionmentioning

confidence: 99%

Anti-infective Medicines Use in Children and Neonates With Pre-existing Kidney Dysfunction: A Systematic Review

et al. 2022

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BackgroundDosing recommendations for anti-infective medicines in children with pre-existing kidney dysfunction are derived from adult pharmacokinetics studies and adjusted to kidney function. Due to neonatal/pediatric age and kidney impairment, modifications in renal clearance and drug metabolism make standard anti-infective dosing for children and neonates inappropriate, with a risk of drug toxicity or significant underdosing. The aim of this study was the systematic description of the use of anti-infective medicines in pediatric patients with pre-existing kidney impairment.MethodsA systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The EMBASE, Medline and Cochrane databases were searched on September 21st, 2021. Studies in all languages reporting data on pre-defined outcomes (pharmacokinetics-PK, kidney function, safety and efficacy) regarding the administration of anti-infective drugs in children up to 18 years with pre-existing kidney dysfunction were included.Results29 of 1,792 articles were eligible for inclusion. There were 13 case reports, six retrospective studies, nine prospective studies and one randomized controlled trial (RCT), reporting data on 2,168 pediatric patients. The most represented anti-infective class was glycopeptides, with seven studies on vancomycin, followed by carbapenems, with five studies, mostly on meropenem. Antivirals, aminoglycosides and antifungals counted three articles, followed by combined antibiotic therapy, cephalosporins, lipopeptides with two studies, respectively. Penicillins and polymixins counted one study each. Nine studies reported data on patients with a decreased kidney function, while 20 studies included data on kidney replacement therapy (KRT). Twenty-one studies reported data on PK. In 23 studies, clinical outcomes were reported. Clinical cure was achieved in 229/242 patients. There were four cases of underdosing, one case of overdosing and 13 reported deaths.ConclusionThis is the first systematic review providing evidence of the use of anti-infective medicines in pediatric patients with impaired kidney function or requiring KRT. Dosing size or interval adjustments in pediatric patients with kidney impairment vary according to age, critical illness status, decreased kidney function and dialysis type. Our findings underline the relevance of population PK in clinical practice and the need of developing predictive specific models for critical pediatric patients.

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Drug Dosing in Pediatric Acute Kidney Insufficiency and Renal Replacement Therapy

Barletta¹,

Barletta²

2019

Critical Care Nephrology

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Drug dosage in continuous venovenous hemofiltration in critically ill children

Cited by 3 publications

References 44 publications

In vivo Elimination of Clonidine by Continuous Venovenous Hemofiltration in Critically Ill Patients

In vivo Elimination of Clonidine by Continuous Venovenous Hemofiltration in Critically Ill Patients

Anti-infective Medicines Use in Children and Neonates With Pre-existing Kidney Dysfunction: A Systematic Review

Drug Dosing in Pediatric Acute Kidney Insufficiency and Renal Replacement Therapy

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