Pharmacokinetics of Commonly Used Medications in Children Receiving Continuous Renal Replacement Therapy: A Systematic Review of Current Literature.
Pharmacokinetics of Commonly Used Medications in Children Receiving Continuous Renal Replacement Therapy: A Systematic Review of Current Literature.
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DOI：
10.1007/s40262-021-01085-z
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发表时间：
2022-03
影响因子：
4.5
通讯作者：
Edginton A
中科院分区：
文献类型：
--
作者：
Dubinsky S;Watt K;Saleeb S;Ahmed B;Carter C;Yeung CHT;Edginton A
The use of CRRT for renal support has increased substantially in critically ill children compared to intermittent modalities due to its preferential effects on hemodynamic stability. With the expanding role of CRRT, the quantification of extracorporeal clearance (CLRRT) and the effect on primary pharmacokinetic parameters is of the utmost importance. Within this review we aimed to summarize the current state of the literature and compare published pharmacokinetic analyses of commonly used medications in children receiving CRRT to those who are not. A systematic search of the literature within electronic databases PubMed, EMBASE, Cochrane Library and Web of Science was conducted. Published studies that were included contained relevant information on use of commonly administered medications to children, from neonates to adolescents, receiving CRRT. Pharmacokinetic parameters that were analyzed included Vd, CLtotal, CLRRT, AUC and elimination half-life. Information regarding CRRT circuit, flow rates and membrane components were analyzed to investigate differences in pharmacokinetics between each modality. 45 studies met final inclusion within this systematic review, totaling 833 pediatric patients, with 586 receiving CRRT. Antimicrobials were the most common pharmacological class represented within the literature, representing 81% (35/43) of studies analyzed. Children receiving CRRT largely had similar Vd and CLtotal to critically ill children not receiving CRRT, suggesting reno-protective dose adjustments may lead to subtherapeutic dosing regimens in these patients. Overall, there was a tendency for hydrophilic agents, with low protein binding to undergo elevated CLtotal in these children. However, results should be interpreted with caution due to the large variability amongst patient populations and heterogeneity with CRRT modalities, flow rates and use of ECMO within studies. This review was able to identify that variation in solute removal, or CRRT modalities, properties (i.e. flow rates) and membrane composition may have differing effects on the pharmacokinetics of commonly administered medications. The current state of the literature of medications administered to children receiving CRRT largely focuses on antimicrobials. Significant gaps remain with other commonly used medications such as sedatives and analgesics. Overall reporting of patient clinical characteristics, CRRT settings and circuit composition was poor, with only 10% of articles including all relevant information to assess the impact of CRRT on CLtotal. Changes in pharmacokinetics because of CRRT often required higher than labelled doses, suggesting renally adjusted, or reno-protective doses may lead to subtherapeutic dosing regimens. A thorough understanding of the interplay between patient, drug and CRRT-circuit factors are required to ensure adequate delivery of dosing regimens to this vulnerable population.
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影响因子：
9.6
作者：
Bates, RD;Nahata, MC;Barson, WJ
通讯作者：
Barson, WJ
影响因子：
4.9
作者：
Beringer, PM;Vinks, AATMM;Shapiro, BJ
通讯作者：
Shapiro, BJ
DOI：
10.1097/00005373-200011000-00013
发表时间：
2000-11-01
影响因子：
--
作者：
Barletta, JF;Johnson, SB;Erstad, BL
通讯作者：
Erstad, BL
影响因子：
3
作者：
Arzuaga, A.;Isla, A.;Pedraz, J. L.
通讯作者：
Pedraz, J. L.
DOI：
10.3390/antibiotics9120887
发表时间：
2020-12-10
期刊：
Antibiotics (Basel, Switzerland)
影响因子：
--
作者：
Butragueño-Laiseca L;Troconiz IF;Grau S;Campillo N;García X;Padilla B;Fernández SN;Santiago MJ
通讯作者：
Santiago MJ