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Drug Dosing in Abnormal Kidney Function in Children

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Pediatric Nephrology

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Abstract

As more than 60% of drugs are cleared by the kidneys, knowledge of drug handling and drug dosing in children with abnormal kidney function is essential. However, predicting drug clearance of drugs by the kidneys is not so straightforward. Very few drugs are actually cleared by glomerular filtration as this process requires that the drug to be unbound to plasma protein and an approprite size. Most drugs are actively transported into the lumen of the tubule and functionally, intact nephron endowment would be required for accurate drug clearance. Unfortunately, ways to assess nephron endowment are not clinically practical and therefore glomerular filtration rate (GFR) remains the best surrogate marker of nephron endowment.

In this chapter we will discuss developmental changes of drug transport, how children handle drugs with normal and impaired kidney function, and general principles of drug dosing in children with chronic kidney disease (CKD). We will also cover drug dosing during renal replacement therapy.

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Abbreviations

AAG:

Acid glycoprotein

AKI:

Acute kidney injury

APD:

Automated peritoneal dialysis

CAPD:

Continuous ambulatory peritoneal dialysis

CAVHF:

Continuous arterio-venous hemofiltration

CKD:

Chronic kidney disease

CRRT:

Continuous renal replacement therapies

CVVH:

Continuous veno-venous hemofiltration

CVVHD:

Continuous veno-venous hemodialysis

CVVHDF:

Continuous veno-venous hemofiltration

CysC:

Cystatin C

ERPF:

Effective renal plasma flow

ESRD:

End-stage renal disease

GFR:

Glomerular filtration rate

HD:

Hemodialysis

IHD:

Intermittent hemodialysis

KDIGO:

Kidney Disease: Improving Global Outcomes

PD:

Peritoneal dialysis

RRF:

Residual renal function

SCUF:

Slow continuous ultrafiltration

SLED:

Sustained low-efficiency dialysis

Vd:

Volume of distribution

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Author information

Authors and Affiliations

  1. Unidad de Investigación y Diagnóstico en Nefrologia y Metabolismo Mineral Óseo, Hospital Infantil de México Federico Gómez, Mexico City, Mexico

    Mara Medeiros

  2. Department of Paediatrics, University of Western Ontario, London, ON, Canada

    Guido Filler

  3. Department of Paediatrics, Children’s Hospital, London Health Sciences Centre, London, ON, Canada

    Guido Filler

Authors
  1. Mara Medeiros
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  2. Guido Filler
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Corresponding author

Correspondence to Mara Medeiros .

Editor information

Editors and Affiliations

  1. Division of Nephrology, Bambino Gesù Children’s Hospital –, ROMA, Roma, Italy

    Francesco Emma

  2. Division of Nephrology and Hypertension The Heart Institute, University of Cincinnati Cincinnati Children’s Hospital Medical C, Cincinnati, OH, USA

    Stuart Goldstein

  3. Division of Nephrology, All India Institute of Medical Sciences, Ansari Nagar East, Delhi, India

    Arvind Bagga

  4. Division of Pediatric Nephrology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Carlton M. Bates

  5. Renal Unit, Graet Ormond Street Hospital, London, UK

    Rukshana Shroff

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Medeiros, M., Filler, G. (2021). Drug Dosing in Abnormal Kidney Function in Children. In: Emma, F., Goldstein, S., Bagga, A., Bates, C.M., Shroff, R. (eds) Pediatric Nephrology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27843-3_141-1

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  • DOI: https://doi.org/10.1007/978-3-642-27843-3_141-1

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  • Print ISBN: 978-3-642-27843-3

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