Adjusting maintenance drug dose for continuous renal replacement therapy*

CRRT: continuous renal replacement therapy.
* This algorithm addresses only the modification of maintenance drug dose with respect to CRRT. Refer to UpToDate topic on drug removal in CRRT for a discussion of determining the optimal loading dose. Patients may require additional dose modifications based on hepatic dysfunction or other comorbidities. This algorithm is only useful for drugs <2000 daltons. It is difficult to predict clearance for drugs between 2000 and 15,000 daltons. However, few drugs fall into this size range; insulin is one such drug at 5805 daltons but is dosed to target effects. There is little if any clearance of drugs >15,000 daltons; most drugs this size are biological agents, such as monoclonal antibodies and soluble receptor antagonists that are dosed to target effects or given as a single dose.
¶ Drugs that are primarily cleared by hepatic or gastrointestinal metabolism and do not have significant pharmacologically active metabolites that are excreted by the kidney do not have to be adjusted for reduced renal function or CRRT clearance.
Δ Refer to UpToDate topic on drug removal in CRRT for the calculation of residual renal function in mL/minute.