Renal Impairment - Mild/Moderate
DoseMeRx takes into account renal impairment based on the pharmacokinetic models in use. When these models are developed, serum creatinine (or creatinine clearance or eGFR) are typically tested as to whether they are predictive of drug levels. DoseMeRx allows the entry of serum creatinine at as many timepoints as you have levels available. Between these timepoints, DoseMeRx interpolates the serum creatinine level to allow a patient’s clearance to adjust over time.
Secondly, DoseMeRx takes into account renal function when calculating guideline and label doses. If no serum creatinine level is available at all, DoseMeRx uses a published model of mean serum creatinine for age, sex, weight, and height.
Finally, because DoseMeRx calculates the relationship between doses given and measured drug concentrations, it takes into account for each individual patient their relationship between creatinine clearance and drug (e.g. vancomycin) rate of clearance.
Fluctuating Renal Function
DoseMeRx handles fluctuating renal function by allowing multiple serum creatinine entries. Of course, serum creatinine is a later marker of renal function, which means that just like any other tool, scoring method, or alerting method that uses serum creatinine, the clinician needs to keep in mind the whole patient; anuria can occur prior to a measurable rise in serum creatinine.
DoseMeRx has a track record of successfully dosing patients with significantly varying renal function over the course of several weeks. DoseMeRx also has been used in numerous facilities to aid in dosing patients with augmented renal clearance.
Acute kidney injury is handled the same way as a mild or moderate renal impairment. By using recorded serum creatinine varying over time, as well as drug concentrations, DoseMe can fit to significant variations. DoseMe does apply limits to the minimum and maximum serum creatinine that can be entered, however, these limits are set per-facility based on your preferences.
While DoseMeRx has not been formally validated for CRRT and we therefore cannot recommend its use in this cohort, we have many customers successfully using DoseMeRx in this patient cohort.
DoseMeRx supports vancomycin dosing in hemodialysis patients. Read article →