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.
0 - 25 eGFR
500mg IV q24h
1g IV q24h
500mg IV daily, dose after dialysis on HD days