Critical Care
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This article is part of a series on Renal replacement therapy, edited by John Kellum and Lui Forni.ReviewClinical review: Drug metabolism and nonrenal clearance in acute kidney injuryA Mary Vilay1  , Mariann D Churchwell2 and Bruce A Mueller1  1
Department of Clinical, Social and Administrative Sciences, University of Michigan College of Pharmacy, 428 Church Street, Ann Arbor, MI 48109-1065, USA 2
University of Toledo, College of Pharmacy, Department of Pharmacy Practice, West Bancroft Street, Toledo, OH 43606-3390, USA  author email corresponding author email
Critical Care 2008,
12:235doi:10.1186/cc7093
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| Published: |
12 November 2008 |
Abstract
Decreased renal drug clearance is an obvious consequence of acute kidney injury (AKI). However, there is growing evidence to suggest that nonrenal drug clearance is also affected. Data derived from human and animal studies suggest that hepatic drug metabolism and transporter function are components of nonrenal clearance affected by AKI. Acute kidney injury may also impair the clearance of formed metabolites. The fact that AKI does not solely influence kidney function may have important implications for drug dosing, not only of renally eliminated drugs but also of those that are hepatically cleared. A review of the literature addressing the topic of drug metabolism and clearance alterations in AKI reveals that changes in nonrenal clearance are highly complicated and poorly studied, but they may be quite common. At present, our understanding of how AKI affects drug metabolism and nonrenal clearance is limited. However, based on the available evidence, clinicians should be cognizant that even hepatically eliminated drugs and formed drug metabolites may accumulate during AKI, and renal replacement therapy may affect nonrenal clearance as well as drug metabolite clearance. | 
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