INTEGRATIVE BIOANALYTICAL STRATEGIES FOR OPTIMISING PHARMACOTHERAPY IN KIDNEY DISORDERS: PRECISION DRUG MONITORING AND THERAPEUTIC RESPONSE EVALUATION IN NEPHROLOGY PRACTICE

Abstract

Kidney diseases (AKI, CKD, ESRD and transplantation) have significant changes in pharmacokinetics and pharmacodynamics, which make the exposure and toxicity even more variable. The traditional renal-based dosing and trough-guided monitoring is not always adequate, particularly in patients who are critically ill and patients under renal replacement therapies. To summarise the role of integrative bioanalytical approaches to enhance pharmacotherapy in nephrology, including precision drug monitoring and evaluation of therapeutic response.  The review is a synthesis of evidence that backs exposure-based surveillance (especially AUC-guided vancomycin dosing), sophisticated treatment systems like LC-MS/MS, and frameworks of model-informed precision dosing of individualised therapy. It puts the fluctuating nature of renal replacement therapy in the limelight, as well as the modifying effect of obesity and other comorbid conditions on drug absorption, and the significance of validated analyses and standard workflows. Therapeutic response assessment is also extended to measure clinical outcome, pharmacodynamic target and evolving biomarkers of kidney injury to allow toxicity to be detected sooner and dose-adjustment to be made more safely, including in transplantation, where the detection of immunosuppressant needs high analytical sensitivity.  An end-to-end, all-encompassing approach to safer, more effective, and more personalised pharmacotherapy in nephrology practice incorporates the concept of integrative bioanalysis, which incorporates accurate drug quantification, pharmacometric modelling, and biomarker-inspired response assessment. The practical implication of integrative bioanalysis has relevance in antimicrobials and immunosuppressants.