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Abstract Continuous renal replacement therapy (CRRT) is used for managing acute kidney injury in critically ill patients. Removal of antiepileptic drugs (AEDs) by CRRT could be significant and may complicate patients' intensive care unit stay. The objective of the current review was to summarize the available evidence for AED removal by CRRT. An electronic literature search of PubMed (1946 to May 2016), Medline (1946 to May 2016), and Embase (1974 to May 2016) databases for studies discussing AED removal by CRRT was conducted. A total of 31 case reports discussing 32 patients were found. AEDs reported were levetiracetam (n = 3), valproic acid (n = 9), carba-mazepine (n = 10), phenytoin (n = 3), phenobarbital (n = 4), lacosamide (n = 1), gabapentin (n = 1), and topiramate (n = 1). Two-thirds of the reports were about using CRRT in drug overdose and one-third was about AED removal by CRRT during therapy. Based on the current limited evidence and pharmacokinetic characteristics of AEDs, renally eliminated AEDs and/or AEDs with limited protein binding such as levetiracetam are more likely to be removed by CRRT than AEDs that are mainly metabolized and extensively protein bound such as carbamazepine. In conclusion, there is not enough evidence to provide robust dosing recommendations for AEDs in patients undergoing CRRT. Further studies are needed.
1Introduction
Continuous renal replacement therapy (CRRT) is used for managing acute kidney injury (AKI) in critically ill patients who are hemodynamically unstable. Drug removal by CRRT could be significant and may complicate patients' intensive care unit (ICU) stay. Data available for antiepileptic drug (AED) removal by CRRT are sparse. With the exception of few proposed dosing changes [1], there are no guidelines or manufacturers' recommendations for AED dosing and monitoring in patients undergoing CRRT. Patients taking AEDs might fall under any of the following three categories: those who are on pre-existing AEDs and about to start CRRT, in whom seizure control might be compromised; those who are newly started on AEDs for seizures or status epilepticus and emergent seizure control is needed; and those who are admitted for AED overdose or toxicity and CRRT might have a role in AED removal.
The objective of the current review was to summarize the available evidence for AED...