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 - 30 eGFR
1-4 MU q8-12h
30 - 50 eGFR
1-4 MU q6h
0.5-4MU IV q4h
Up to 2 million units IV q4h- administer after dialysis on HD days. Pharmacist review recommended
2 million units IV q4h