Pharmacokinetics and dosing of vancomycin in patients undergoing sustained low efficiency daily diafiltration (SLEDD-f): A prospective study
Journal
Journal of the Formosan Medical Association
Journal Volume
120
Journal Issue
1
Pages
737-743
Date Issued
2021
Author(s)
Abstract
Background/purpose: The pharmacokinetics of vancomycin in patients who undergo sustained low efficiency daily diafiltration (SLEDD-f) is not clear. This study aimed to determine the appropriate vancomycin dosage regimen for patients receiving SLEDD-f. Methods: This prospectively observational study enrolled critically ill patients older than 18 years old that used SLEDD-f as renal replacement therapy and received vancomycin treatment. An 8-h SLEDD-f was performed with FX-60 (high-flux helixone membrane, 1.4 m2). Serial blood samples were collected before, during, and after SLEDD-f to analyse vancomycin serum concentrations. Effluent fluid samples (a mixture of dialysate and ultrafiltrate) were also collected to determine the amount of vancomycin removal. Results: Seventeen patients were enrolled, and 10 completed the study. The amount of vancomycin removal was 447.4 ± 88.8 mg (about 78.4 ± 18.4% of the dose administered before SLEDD-f). The vancomycin concentration was reduced by 57.5 ± 14.9% during SLEDD-f, and this reduction was followed by a rebound with duration of one to three hours. The elimination half-life of vancomycin decreased from 64.1 ± 35.7 h before SLEDD-f to 7.0 ± 3.0 h during SLEDD-f. Conclusion: Significant amount of vancomycin removed during SLEDD-f. Despite the existence of post-dialysis rebound, a sufficient supplemental dose is necessary to maintain therapeutic range. ? 2020 Formosan Medical Association
SDGs
Other Subjects
heparin; vancomycin; antiinfective agent; vancomycin; acute kidney failure; adult; Article; blood sampling; clinical article; controlled study; critically ill patient; diafiltration; drug blood level; drug dose regimen; drug elimination; drug monitoring; effluent; elimination half-life; end stage renal disease; female; high performance liquid chromatography; human; infection control; loading drug dose; maintenance drug dose; male; medical care; observational study; pharmacokinetic parameters; prospective study; renal replacement therapy; sustained lowefficiency daily diafiltration; treatment duration; ultrafiltration; adolescent; critical illness; Acute Kidney Injury; Adolescent; Anti-Bacterial Agents; Critical Illness; Humans; Hybrid Renal Replacement Therapy; Prospective Studies; Vancomycin
Publisher
Elsevier B.V.
Type
journal article