Aminoglycoside use in patients with chronic kidney disease

Aminoglycosides are a valuable tool in the management of Gramnegative infections. However, they are also notorious for their potentially harmful adverse effects, in particular, ototoxicity and nephrotoxicity. There remains confusion amongst clinicians regarding the optimal way to dose and monitor aminoglycosides in patients with impaired renal function, in order to achieve maximal antimicrobial efficacy with minimal toxicity. In this chapter, we will discuss the use of aminoglycosides in treating patients with chronic kidney disease and those receiving dialysis. In particular, the pharmacokinetics of aminoglycosides, including absorption, distribution and elimination, as well as their qualities of concentration-dependent killing and postantibiotic effect, will be summarised. We will review the complications and toxicity issues relating to use of aminoglycosides and how these risks are altered in patients with impaired renal function. Lastly, the dosing and monitoring of aminoglycosides in patients with chronic kidney disease, including those receiving haemodialysis, and in those receiving peritoneal dialysis (including intraperitoneal administration of aminoglycosides) will be outlined, to help guide clinical decision-making.