Abstract

DIAS, Bruno Fraga  and  SANTOS, Josefina. Principles of Antibiotic Adjustment in Renal Failure. Port J Nephrol Hypert [online]. 2023, vol.37, n.4, pp.217-225.  Epub Dec 30, 2023. ISSN 0872-0169.  https://doi.org/10.32932/pjnh.2023.12.267.

The incidence and prevalence of patients with acute kidney injury and chronic kidney disease have increased significantly in recent years. Renal failure is associated with profound changes in the pharmacokinetics and pharmacodynamics of antibiotics. It is widely recognized that inadequate adjustment of antibiotics can lead to undertreatment and impair the patient’s clinical outcome.

The difficulty of adjusting drugs in renal dysfunction begins with estimating renal function (urinary clearance of inulin is rarely performed, and creatinine/cystatin-based formulas have widely recognized limitations, especially in acute kidney injury). Management becomes more complex, given the frequent changes in the volume of distribution and the introduction of different renal replacement therapies. Efforts must be made to optimize antibiotic targets in this population.

This study aims to review the principal pharmacokinetic and pharmacodynamic modifications that occur with antibiotics in chronic kidney disease and acute kidney injury, with the goal of offering strategies to enhance antibiotic therapy in these scenarios.

Keywords : Acute Kidney Injury; Anti-Bacterial Agents/administration & dosage; Anti-Bacterial Agents/pharmacology; Anti-Bacterial Agents/pharmacokinetics; Dose-Response Relationship, Drug; Drug Dosage Calculations; Kidney Diseases/drug therapy; Renal Insufficiency, Chronic; Renal Replacement Therapy.

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