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.
eGFR 0 - 10
1-2g IV q24h
eGFR 10 - 40
1-2g IV q12h
eGFR 40 - 60
1-2g IV q8h
eGFR > 60
2g IV q8h
1-2g IV given post-HD on dialysis days only
1-2g IV q12h
