In the setting of rapidly improving/worsening renal function, calculations of eGFR are inaccurate, and dosing should be based on estimated renal function instead.
If worsening renal function, actual GFR is likely lower than calculated.
If improving renal function, actual GFR is likely higher than calculated eGFR.
Not On Dialysis (EGFR)
2g IV q12-24h
2g IV q6-12h
2g IV q6h
Intermittent Dialysis
1-2g IV q12-24h, dose after HD on dialysis days
Continuous Dialysis
Load 2g then 1-2g IV q6h