KDIGO Clinical Practice Guideline for Acute Kidney Injury
Research Recommendations

Research recommendations

• No standard method exists for therapeutic drug monitoring of aminoglycosides by single daily dosing. Uniform guidance, based upon carefully performed pharmacokinetic/ pharmacodynamic studies on the optimal timing and method of therapeutic drug monitoring with singledaily dosing regimens, would be of great assistance.³¹⁹
• It is generally recommended that patients receiving extended-dosing interval aminoglycosides should have aminoglycosides administered at even greater dosing intervals if mild or moderate degrees of underlying renal impairment exist. Optimal therapeutic monitoring in the setting of infrequent dosing intervals for patients with underlying CKD needs to be standardized and uniform recommendations need to be provided by careful pharmacokinetic/pharmacodynamic observational studies.
• The impact of IHD and high-flux CRRTupon the efficacy and toxicity of extended-duration dosing of aminoglycosides needs further study. As membranes with greater sieving coefficients come into greater use, the impact on aminoglycoside elimination needs to be carefully considered. This could be investigated by RCTs using standard dosing intervals vs. individualized dosing regimens, with frequent drug-level monitoring and the use of efficacy measures and kidney injury markers as outcomes.
• The interaction between aminoglycosides and other antimicrobial agents, and other therapeutic agents with nephrotoxic potential needs to be more carefully quantified. The degree of aminoglycoside-induced nephrotoxicity alone vs. combination effects with such drugs as vancomycin, amphotericin B, cephalosporins, extended-spectrum penicillins, colistin, loop diuretics, clindamycin, cisplatin, and nonsteroidal anti-inflammatory agents needs to be more carefully examined in observational studies.