Factors Influencing Vancomycin Loading Dose for Hospitalized Hemodialysis Patients: Prospective Observational Cohort Study

Autor:	Michelle Dehoorne-Smith, Wasim S El Nekidy, Maher M El-Masri, Greg S Umstead
Rok vydání:	2012
Předmět:	Gynecology medicine.medical_specialty Pediatrics Stage 5 chronic kidney disease business.industry medicine.medical_treatment Articles Pharmacy Loading dose Patient age medicine Vancomycin Pharmacology (medical) In patient Hemodialysis Dosing business Cohort study medicine.drug
Zdroj:	The Canadian Journal of Hospital Pharmacy. 65
ISSN:	1920-2903 0008-4123
DOI:	10.4212/cjhp.v65i6.1191
Popis:	Background : The increasing use of vancomycin to treat methicillinresistant Staphylococcus aureus (MRSA) has resulted in reduced susceptibility of MRSA to this drug. It is important to optimize vancomycin dosing in patients who are undergoing hemodialysis to attain a pre-hemodialysis serum concentration sufficient to eradicate MRSA, in accordance with recent guideline recommendations. Objectives : To establish the optimal strategy for vancomycin loading dose in patients undergoing hemodialysis and to explore the determinants of pre-hemodialysis serum concentration of vancomycin measured in these patients. Methods : A prospective observational cohort study was conducted between January and June 2010. Eligible participants were adults with established stage 5 chronic kidney disease who were undergoing inpatient hemodialysis. Data were collected on loading dose administered, body weight, serum concentration of vancomycin before the subsequent hemodialysis session (pre-hemodialysis concentration), and time between end of vancomycin infusion and measurement of pre-hemodialysis serum concentration. Multivariate stepwise linear regression was performed to examine independent associations between variables and measured pre-hemodialysis serum concentration of vancomycin. Results : Eighty-one patients were included in the study. Of 24 patients who achieved the recommended pre-hemodialysis serum concentration of vancomycin (15–20 mg/L), 14 had a loading dose between 15 and 20 mg/kg. Further analysis suggested that the pre-hemodialysis serum concentration of vancomycin was independently associated with weightbased loading dose (mg/kg) (s = 0.293, p = 0.003), age (s = –0.358, p < 0.001), and time between administration of the loading dose and initiation of hemodialysis (s = –0.247, p = 0.011). Conclusions : The findings of this study indicate that a loading dose of 15–20 mg/kg (actual body weight) is likely to yield an optimal pre-hemodialysis serum concentration at a median elapsed time of 24 h. In addition to loading dose, patient age and time between administration of the loading dose and initiation of hemodialysis also influenced the pre-hemodialysis serum concentration of the drug. RESUME Contexte : L’utilisation accrue de vancomycine pour traiter les infections a Staphylococcus aureus resistant a la methicilline (SARM) a entraine une reduction de la sensibilite du SARM a ce medicament. Il est important d’optimiser la posologie de la vancomycine chez les patients hemodialyses pour obtenir une concentration serique prealable a l’hemodialyse suffisante pour eradiquer le SARM, conformement aux recommandations recentes des lignes directrices. Objectifs : Etablir la dose d’attaque optimale de la vancomycine chez les patients subissant une hemodialyse et examiner les determinants de la concentration serique de la vancomycine prealable a l’hemodialyse chez ces patients. Methodes : Une etude de cohorte observationnelle prospective a ete menee entre janvier et juin 2010. Les patients admissibles etaient des adultes atteints d’une nephropathie chronique de stade 5 subissant une hemodialyse en milieu hospitalier. Les donnees ont ete recueillies pour la dose d’attaque administree, le poids corporel, la concentration serique de vancomycine avant la seance d’hemodialyse subsequente (concentration prealable a l’hemodialyse) et le temps entre la fin de la perfusion de la vancomycine et la mesure de la concentration serique prealable a l’hemodialyse. Une analyse par regression lineaire sequentielle a ete realisee pour examiner les associations independantes entre les variables et la concentration serique de vancomycine mesuree avant l’hemodialyse. Resultats : Au total, 81 patients ont ete admis a l’etude. Des 24 patients qui ont obtenu la concentration serique de vancomycine recommandee prealablement a l’hemodialyse (15–20 mg/L), 14 ont recu une dose d’attaque de 15 a 20 mg/kg. D’autres analyses ont suggere que la concentration serique de vancomycine prealable a l’hemodialyse etait associee de facon independante a la dose d’attaque fondee sur le poids (mg/kg) (s = 0,293, p = 0,003), a l’âge (s = –0,358, p < 0,001) et au temps ecoule entre l’administration de la dose d’attaque et le debut de l’hemodialyse (s = –0,247, p =0,011). Conclusions : Les resultats de cette etude montrent qu’une dose d’attaque de 15 a 20 mg/kg (poids corporel reel) est susceptible de produire une concentration serique optimale de vancomycine prealablement a l’hemodialyse dans un temps median de 24 h. Outre la dose d’attaque, l’âge du patient et le temps ecoule entre l’administration de la dose d’attaque et le debut de l’hemodialyse ont egalement influence la concentration serique de vancomycine prealable a l’hemodialyse.
Databáze:	OpenAIRE
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