Analgesic and sedative drug dosing in critically ill patients with Acute Kidney Injury undergoing different modalities of Kidney Replacement Therapy.

Critically ill patients frequently require analgesic and sedative medications to manage pain, agitation, and the stress associated with their condition. The onset of Acute Kidney Injury (AKI) can complicate the pharmacokinetics of these drugs, requiring careful dose adjustments to prevent adverse effects. Additionally, Kidney Replacement Therapy (KRT) may further influence drug metabolism and clearance. As renal dysfunction may alter the elimination of these medications, a comprehensive understanding of their pharmacologic profiles and the impact of KRT is essential for optimizing pain and sedation management in critically ill patients. In particular, this review explores the challenges and strategies involved in dosing analgesic and sedative drugs in critically ill patients with AKI undergoing various KRT modalities, including intermittent hemodialysis (IHD), continuous kidney replacement therapy (CKRT), and prolonged intermittent kidney replacement therapy (PIKRT). Moreover, this narrative review is aimed at summarizing existing evidence on pharmacokinetic alterations, clearance rates and eventual dose adjustments in critically ill patients with AKI undergoing various KRT modalities. Special emphasis is placed on the effects of different KRT modalities on drug elimination and associated therapeutic implications, seeking to provide healthcare professionals with evidence-based guidelines for the safe and effective administration of analgesics and sedatives in this complex, high-risk patient population.