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E Keller - One of the best experts on this subject based on the ideXlab platform.
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Drug Dosage in patients during continuous renal replacement therapy pharmacokinetic and therapeutic considerations
Clinical Pharmacokinectics, 1993Co-Authors: P Reetzebonorden, Joachim Böhler, E KellerAbstract:The advantages of continuous haemofiltration and haemodialysis over intermittent haemodialysis for the treatment of acute renal failure are well recognised. In intensive care patients, 4 different continuous procedures, arteriovenous and venovenous haemofiltration (CAVH and CVVH) or haemodialysis (CAVHD and CVVHD), are employed. These effective detoxification treatments require knowledge of their influence on Drug disposition. Data on kinetics of Drugs during continuous treatment are scarce and limited almost exclusively to the oldest and least effective procedure (CAVH). Selected dialysis membranes may adsorb Drugs, as in the case of aminoglycosides. In addition, elimination of substances with large molecular weights may vary depending on the pore size of the membrane, as in the case of vancomycin. Thus, even if Drug Dosages can be based on pharmacokinetic studies, selection of a dialysis membrane not studied may cause unpredictable Drug concentrations. With these limitations in mind and considering the available literature on pharmacokinetics in patients with renal failure, general guidelines for Drug Dosage during continuous renal replacement therapy can be given.
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Drug Dosage in Patients during Continuous Renal Replacement Therapy
Clinical Pharmacokinetics, 1993Co-Authors: P. Reetze-bonorden, Joachim Böhler, E KellerAbstract:The advantages of continuous haemofiltration and haemodialysis over intermittent haemodialysis for the treatment of acute renal failure are well recognised. In intensive care patients, 4 different continuous procedures, arteriovenous and venovenous haemofiltration (CAVH and CVVH) or haemodialysis (CAVHD and CVVHD), are employed. These effective detoxification treatments require knowledge of their influence on Drug disposition. Data on kinetics of Drugs during continuous treatment are scarce and limited almost exclusively to the oldest and least effective procedure (CAVH). Selected dialysis membranes may adsorb Drugs, as in the case of aminoglycosides. In addition, elimination of substances with large molecular weights may vary depending on the pore size of the membrane, as in the case of vancomycin. Thus, even if Drug Dosages can be based on pharmacokinetic studies, selection of a dialysis membrane not studied may cause unpredictable Drug concentrations. With these limitations in mind and considering the available literature on pharmacokinetics in patients with renal failure, general guidelines for Drug Dosage during continuous renal replacement therapy can be given. In haemofiltration, Drug protein binding is the major factor determining sieving, i.e. the appearance of the Drug in the ultrafiltrate. In haemodialysis, diffusion is added to ultrafiltration, and therefore the saturation of the combined dialysate and ultrafiltrate will decrease further with increasing dialysate flow rate. In continuous haemofiltration or haemodialysis the extracorporeal clearance can be calculated by multiplying the saturation value (estimated or, better, measured) with the ultrafiltrate and dialysate flow rate. Dividing the extracorporeal clearance by the total clearance (including the nonrenal clearance) gives the fraction of the dose removed due to extracorporeal elimination. Whether Dosage recommendations available for anuric patients have to be modified or not can be decided on the basis of this value. In case of high nonrenal clearance, the degree of saturation is without clinical significance. Based on these considerations guidelines have been constructed for the effect of extracorporeal elimination on more than 120 different Drugs commonly used in intensive care patients.
P. Reetze-bonorden - One of the best experts on this subject based on the ideXlab platform.
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Drug Dosage in Patients during Continuous Renal Replacement Therapy
Clinical Pharmacokinetics, 1993Co-Authors: P. Reetze-bonorden, Joachim Böhler, E KellerAbstract:The advantages of continuous haemofiltration and haemodialysis over intermittent haemodialysis for the treatment of acute renal failure are well recognised. In intensive care patients, 4 different continuous procedures, arteriovenous and venovenous haemofiltration (CAVH and CVVH) or haemodialysis (CAVHD and CVVHD), are employed. These effective detoxification treatments require knowledge of their influence on Drug disposition. Data on kinetics of Drugs during continuous treatment are scarce and limited almost exclusively to the oldest and least effective procedure (CAVH). Selected dialysis membranes may adsorb Drugs, as in the case of aminoglycosides. In addition, elimination of substances with large molecular weights may vary depending on the pore size of the membrane, as in the case of vancomycin. Thus, even if Drug Dosages can be based on pharmacokinetic studies, selection of a dialysis membrane not studied may cause unpredictable Drug concentrations. With these limitations in mind and considering the available literature on pharmacokinetics in patients with renal failure, general guidelines for Drug Dosage during continuous renal replacement therapy can be given. In haemofiltration, Drug protein binding is the major factor determining sieving, i.e. the appearance of the Drug in the ultrafiltrate. In haemodialysis, diffusion is added to ultrafiltration, and therefore the saturation of the combined dialysate and ultrafiltrate will decrease further with increasing dialysate flow rate. In continuous haemofiltration or haemodialysis the extracorporeal clearance can be calculated by multiplying the saturation value (estimated or, better, measured) with the ultrafiltrate and dialysate flow rate. Dividing the extracorporeal clearance by the total clearance (including the nonrenal clearance) gives the fraction of the dose removed due to extracorporeal elimination. Whether Dosage recommendations available for anuric patients have to be modified or not can be decided on the basis of this value. In case of high nonrenal clearance, the degree of saturation is without clinical significance. Based on these considerations guidelines have been constructed for the effect of extracorporeal elimination on more than 120 different Drugs commonly used in intensive care patients.
Joachim Böhler - One of the best experts on this subject based on the ideXlab platform.
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Individualized Drug Dosage in patients treated with continuous hemofiltration
Kidney international. Supplement, 1999Co-Authors: Frieder Keller, Joachim Böhler, David Czock, Dietmar Zellner, Andreas MertzAbstract:Individualized Drug Dosage in patients treated with continuous hemofiltration. Background Subtherapeutic Drug dosing may be even more dangerous than overDosage, especially for intensive care patients requiring hemofiltration. Proposal According to Dettli's fundamental equation, body clearance of any Drug (Cl) is a linear function of creatinine clearance (Cl = Cl anur + a · C Cr ), with [a = (Cl norm - Cl anur)/C Cr norm]. We propose to individualize Drug Dosage during high-flux hemofiltration by basing it on Dettli's equation and on total C Cr (C Cr tot=C Cr ren + C Cr filt). Using this approach, Drug clearance will eventually be overestimated for Drugs with substantial tubular secretion and for high-efficiency hemofiltration (C Cr tot > 30 ml/min). Conclusion In patients undergoing hemofiltration, the total C Cr approach might be a practical alternative to standardized dosing schemes for deriving an individualized Dosage from published pharmacokinetic data and functions.
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Drug Dosage in patients during continuous renal replacement therapy pharmacokinetic and therapeutic considerations
Clinical Pharmacokinectics, 1993Co-Authors: P Reetzebonorden, Joachim Böhler, E KellerAbstract:The advantages of continuous haemofiltration and haemodialysis over intermittent haemodialysis for the treatment of acute renal failure are well recognised. In intensive care patients, 4 different continuous procedures, arteriovenous and venovenous haemofiltration (CAVH and CVVH) or haemodialysis (CAVHD and CVVHD), are employed. These effective detoxification treatments require knowledge of their influence on Drug disposition. Data on kinetics of Drugs during continuous treatment are scarce and limited almost exclusively to the oldest and least effective procedure (CAVH). Selected dialysis membranes may adsorb Drugs, as in the case of aminoglycosides. In addition, elimination of substances with large molecular weights may vary depending on the pore size of the membrane, as in the case of vancomycin. Thus, even if Drug Dosages can be based on pharmacokinetic studies, selection of a dialysis membrane not studied may cause unpredictable Drug concentrations. With these limitations in mind and considering the available literature on pharmacokinetics in patients with renal failure, general guidelines for Drug Dosage during continuous renal replacement therapy can be given.
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Drug Dosage in Patients during Continuous Renal Replacement Therapy
Clinical Pharmacokinetics, 1993Co-Authors: P. Reetze-bonorden, Joachim Böhler, E KellerAbstract:The advantages of continuous haemofiltration and haemodialysis over intermittent haemodialysis for the treatment of acute renal failure are well recognised. In intensive care patients, 4 different continuous procedures, arteriovenous and venovenous haemofiltration (CAVH and CVVH) or haemodialysis (CAVHD and CVVHD), are employed. These effective detoxification treatments require knowledge of their influence on Drug disposition. Data on kinetics of Drugs during continuous treatment are scarce and limited almost exclusively to the oldest and least effective procedure (CAVH). Selected dialysis membranes may adsorb Drugs, as in the case of aminoglycosides. In addition, elimination of substances with large molecular weights may vary depending on the pore size of the membrane, as in the case of vancomycin. Thus, even if Drug Dosages can be based on pharmacokinetic studies, selection of a dialysis membrane not studied may cause unpredictable Drug concentrations. With these limitations in mind and considering the available literature on pharmacokinetics in patients with renal failure, general guidelines for Drug Dosage during continuous renal replacement therapy can be given. In haemofiltration, Drug protein binding is the major factor determining sieving, i.e. the appearance of the Drug in the ultrafiltrate. In haemodialysis, diffusion is added to ultrafiltration, and therefore the saturation of the combined dialysate and ultrafiltrate will decrease further with increasing dialysate flow rate. In continuous haemofiltration or haemodialysis the extracorporeal clearance can be calculated by multiplying the saturation value (estimated or, better, measured) with the ultrafiltrate and dialysate flow rate. Dividing the extracorporeal clearance by the total clearance (including the nonrenal clearance) gives the fraction of the dose removed due to extracorporeal elimination. Whether Dosage recommendations available for anuric patients have to be modified or not can be decided on the basis of this value. In case of high nonrenal clearance, the degree of saturation is without clinical significance. Based on these considerations guidelines have been constructed for the effect of extracorporeal elimination on more than 120 different Drugs commonly used in intensive care patients.
Markus Daschner - One of the best experts on this subject based on the ideXlab platform.
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Drug Dosage in children with reduced renal function
Pediatric Nephrology, 2005Co-Authors: Markus DaschnerAbstract:Drug dosing in paediatric nephrology requires multiple considerations and is therefore time-consuming and error-prone. This review combines dose adjustment guidelines for children with renal failure and information on the immature renal function of neonates and premature babies in order to help both paediatric nephrologists and neonatologists estimate Drug doses for their patients.
Liu Jian-ping - One of the best experts on this subject based on the ideXlab platform.
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Controlling Drug Dosage Based on Gold Zone Method to Reduce Adverse Drug Reaction
Chinese Journal of Evidence-Based Medicine, 2012Co-Authors: Liu Jian-pingAbstract:What Drug Dosage range is appropriate for treatment? What Drug Dosage range can maximally reduce the incidence of adverse Drug reaction(ADR)? The gold zone method as a new method of evidence-based medical research was proposed to study those two blind areas of Drug Dosage in this article.Studying the dose-effect relationship,taking gold zone as the middle range and dividing empirical range into 3 sections were the key to study design.The evidence-based survey with extremely large sample showed a U-shaped rule existing between the antibiotics' Dosage and the incidence of ADR;and the Dosage in gold zone appeared at the bottom of U-shaped curve.The gold zone method for determining Dosage is a special breakthrough currently for solving those two blind areas of Drug Dosage.
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Disposal of Blind Areas of Drug Dosage by Gold Zone Method
China Pharmacy, 2010Co-Authors: Liu Jian-pingAbstract:OBJECTIVE:To investigate the corresponding method for blind area of actual demand of Drug Dosage.METHODS:Gold zone method was proposed on the basis of the probability theory and mathematical statistics for handling the problems of inaccurate Drug Dosage.RESULTS CONCLUSIONS:Gold zone method can make Drug Dosage being close to actual demand,overcome extreme tendency to reduce accidents.This method is effective and of significance to Dosage of TCM,chemical medicine,even to children medication and rational use of Drugs.
