The production of creatinine is regulated by numerous factors such as diet composition and amount, patient muscle mass, liver function, age, and sex, which can bias the value of this biomarker. Serum creatinine is the most commonly used clinical biomarker for estimation of renal function and drug dosage adjustment in patients with chronic kidney disease. In the absence of therapeutic drug monitoring, a surrogate biomarker of this impaired drug clearance mechanism is used. Anti-infective serum concentrations should be determined and patient-specific dosage adjustments made on the basis of these determinations, when appropriate. An alternative to the elongation of the interval between doses is a reduction of the daily dose given at the usual dosing interval. Specific dosing guidance may not be present for these various dialysis modalities and so will require an educated decision based on the pharmacology of the anti-infective.

However, these forms of renal replacement therapies now encompass multiple potential modalities, such as (1) hi-flux hemodialysis (2) nocturnal hemodialysis (3) slow-low efficiency hemodialysis and (4) continuous veno-venous hemodiafiltration. Bertino Jr., in Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases (Eighth Edition), 2015 Dosage Adjustment for Renal Impairmentĭrug half-lives in adults with impaired renal function and changes related to dialysis procedures (e.g., hemodialysis, peritoneal dialysis) are summarized for the user.

Half life rule 34