Pharmacokinetic considerations in renal failure

The renal system is pivotal, directly or indirectly, in determining the pharmacokinetic properties of the majority of medications used in intensive care units. Pharmacokinetics is defined as the time course of drug behavior in the body. Thus it is the study of drug absorption, distribution, metabolism, and excretion. The use of patient-specific pharmacokinetic parameters allows the clinician to modify clinical response according to serum drug concentrations. Pharmacokinetic variability is greater in intensive care patients. The multiple pathological processes that occur in this patient group may affect many organs of the body which, in turn, influence absorption, distribution, metabolism, and elimination. Predominantly, the distribution and elimination phases (and to a lesser extent absorption and metabolism) are affected by renal dysfunction (Rudy..aD,d...BraterJ994).

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