Removal of vancomycin administered during dialysis by a high-flux dialyzer
| Autor: | Harry O. Senekjian, Heather Nyman, John K. Leypoldt, Alfred K. Cheung, Adhish Agarwal |
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| Rok vydání: | 2018 |
| Předmět: |
business.industry
medicine.medical_treatment Vancomycin Dose 030232 urology & nephrology Area under the curve Hematology 030204 cardiovascular system & hematology Crossover study 03 medical and health sciences 0302 clinical medicine Nephrology Anesthesia Medicine Vancomycin Chronic hemodialysis Dosing Hemodialysis business Dialysis (biochemistry) medicine.drug |
| Zdroj: | Hemodialysis International. 22:383-387 |
| ISSN: | 1492-7535 |
| DOI: | 10.1111/hdi.12637 |
| Popis: | Introduction Hemodialysis patients frequently receive vancomycin for treatment of gram-positive bacterial infections. This drug is most conveniently administered in outpatient dialysis units during the hemodialysis treatment. However, there is a paucity of data on the removal of vancomycin by high-flux polyamide dialyzers. Methods This is a prospective crossover study in which seven uninfected chronic hemodialysis patients at three dialysis units received vancomycin 1 gram intravenously over one hour immediately after the dialysis treatment (Phase 1), and vancomycin 1.5 grams during the last hour of dialysis treatment using a polyarylethersulfone, polyvinylpyrrolidone, polyamide high-flux (Polyflux 24R) dialyzer (Phase 2). There was a three-week washout period between phases. Serial serum vancomycin concentrations were used to determine the removal of vancomycin when administered during dialysis. Findings Dialysis removed 35 ± 15% (range 18-56%) of the vancomycin dose when administered during the last hour of dialysis. The calculated area under the curve (AUC) of vancomycin levels for 0-44.5 hours from the start of infusion were similar between the two phases (AUCPhase 1 884 ± 124 mg-hr/L, mean ± SD; AUCPhase 2 856 ± 208 mg-hr/L; P=0.72). Serum vancomycin concentrations immediately prior to the next dialysis treatment following vancomycin administration were also similar between the two phases (13.1 ± 2.7 mg/L in Phase 1 and 12.3 ± 3.3 mg/L in Phase 2; P=0.55). Discussion When using a polyarylethersulfone, polyvinylpyrrolidone, and polyamide high-flux HD membrane with a 24R Polyflux dialyzer, vancomycin can be administered during the last hour of dialysis if the dose that is prescribed for intra-dialysis dosing is empirically increased to account for intra-dialytic drug removal. |
| Databáze: | OpenAIRE |
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