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)
750mg IV/PO load then 500mg IV/PO q48h
500-750mg IV/PO q48h
500-750mg IV/PO daily
Intermittent Dialysis
750mg IV/PO load then 500mg QHD
Continuous Dialysis
750mg IV/PO load then 500mg IV/PO q48h