What effect does acute kidney injury have on drug dosing in the ICU?

Acute kidney injury (AKI) significantly impacts drug dosing, particularly for medications that are primarily excreted by the kidneys. When kidney function declines, the body's ability to eliminate these drugs is compromised, increasing the risk of drug accumulation and potential toxicity. Therefore, clinicians must consider kidney function when determining appropriate dosages for renally excreted medications.

Adjusting the dose of these medications ensures patient safety and efficacy, as normal dosing regimens may lead to higher than intended drug levels in the bloodstream. In the context of critical care, where patients might already be at high risk for adverse drug reactions, careful monitoring and modification of dosing based on kidney function are essential components of safe and effective pharmacotherapy.

In contrast, increased drug absorption is not a typical consequence of AKI; rather, the absorption processes are influenced more by gastrointestinal perfusion and health. Additionally, AKI cannot be ignored in the context of all medications, as it primarily calls for adjustments in those agents handled through renal clearance. Thus, the effects of AKI are most relevant to renally excreted drugs, confirming that dose adjustments are necessary to avoid toxicity.