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.
1-2g IV q12-24h
1-2g IV q6-12h
1-2g IV q4-6h
1-2g IV q12-24h, dose after HD on dialysis days
Load 2g then 1-2g IV q6-12h
1-2g IV q12h