Vancomycin hemodialysis: Clearance differences between high-flux hemodialysis and on-line hemodiafiltration

被引:8
作者
Rodriguez, Nestor [1 ]
Gomez, Miquel [2 ]
Rico, Naira [1 ]
Maria Campistol, Josep [1 ]
Maduell, Francisco [1 ]
机构
[1] Hosp Clin Barcelona, Nephrol & Renal Transplantat Dept, Barcelona, Spain
[2] Hosp Clin Barcelona, FCRB, LENIT, Barcelona, Spain
关键词
clearance; hemodiafiltration; high-flux hemodialysis; vancomycin; RESISTANT STAPHYLOCOCCUS-AUREUS; REMOVAL; PHARMACOKINETICS; MORTALITY; DIALYSIS;
D O I
10.1111/aor.13368
中图分类号
R318 [生物医学工程];
学科分类号
0831 ;
摘要
The aim of this study was to analyze the differences between vancomycin clearance (Kd) with high-flux hemodialysis (HFHD) and on-line hemodiafiltration (OL-HDF). The OL-HDF therapy combined the diffusion and convective transport of solutes. To compare the Kd, a vancomycin loading dose of 1 g was administered intravenously post-dialysis to 11 chronic and anuric (<100 mL/24 h) hemodialysis patients, undergoing HFHD and post-dilution al OL-HDF in consecutive therapies. Additional doses of 0.5 g were administered after 45 minutes at the end of each dialysis therapy during antibiotic treatment. Blood samples were drawn from arterial and venous lines at the start of hemodialysis sessions and at the first, second, third, and fourth hours. Additional samples were drawn at 15, 30, and 45 minutes after the end of dialysis therapy. Vancomycin plasma concentration, blood urea nitrogen (BUN), creatinine, and beta(2)-microglobulin were measured. The patients' hydration status was evaluated by bioimpedance analysis. The mean of vancomycin dialyser clearance (Kd(dc)) calculated was 110.8 +/- 15 mUmin with HFHD and 146.8 +/- 13.8 mL/min with OL-HDF (P = 0.025). Significant differences were also obtained for 13 2 -mieroglobulin clearance, Kd(dc) 72.6 +/- 15.4 mL/min with HFHD and 113.4 +/- 24.2 mL/min with OL-HDF = 0.012), whereas no differences were found for BUN or creatinine. Additionally, to analyze differences between HFHD and OL-HDF, a variable volume dual pool mathematical model was developed to estimate the body clearance (Kd(bc)), extraction mass (M-e), and inter-compartment mass-transfer coefficient (K-12) of each molecule. A higher vancomycin Kd(dc), with OL-HDF produced by convection improved removal of antibiotic; this can compromise achieving a therapeutic concentration target. We recommended evaluating increased loading doses of vancomycin and avoiding administration during OL-HDF to assure adequate treatment.
引用
收藏
页码:261 / 269
页数:9
相关论文
共 35 条
[1]  
Bravo JJ, 2005, NEFROLOGIA, V25, P527
[2]  
Clark WR, 1999, J AM SOC NEPHROL, V10, P601
[3]   Vancomycin Pharmacokinetics and Pharmacodynamics during Short Daily Hemodialysis [J].
Decker, Brian S. ;
Kays, Michael B. ;
Chambers, Mary ;
Kraus, Michael A. ;
Moe, Sharon M. ;
Sowinski, Kevin M. .
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2010, 5 (11) :1981-1987
[4]   Online hemodiafiltration reduces systemic inflammation compared to low-flux hemodialysis [J].
den Hoedt, Claire H. ;
Bots, Michiel L. ;
Grooteman, Muriel P. C. ;
van der Weerd, Neelke C. ;
Mazairac, Albert H. A. ;
Penne, E. Lars ;
Levesque, Renee ;
ter Wee, Piet M. ;
Nube, Menso J. ;
Blankestijn, Peter J. ;
van den Dorpel, Marinus A. .
KIDNEY INTERNATIONAL, 2014, 86 (02) :423-432
[5]  
DESOI CA, 1992, AM J KIDNEY DIS, V20, P354
[6]  
Eloot S, 2004, THESIS GHENT U GENT
[7]  
FLOEGE J, 1991, J LAB CLIN MED, V118, P153
[8]  
Hairer E., 1993, Solving Ordinary Differential Equations I: Nonstiff Problems, V8, DOI [DOI 10.1007/978-3-540-78862-1, 10.1007/978-3-540-78862-1]
[9]   Optimization of anti-infective dosing regimens during online haemodiafiltration [J].
Jager, Nynke G. L. ;
Zandvliet, Anthe S. ;
Touw, Daniel J. ;
Penne, Erik L. .
CLINICAL KIDNEY JOURNAL, 2017, 10 (02) :282-290
[10]   AN ESTIMATE OF BETA(2)-MICROGLOBULIN DEPOSITION RATE IN UREMIC PATIENTS ON HEMODIALYSIS USING A MATHEMATICAL KINETIC-MODEL [J].
KANAMORI, T ;
SAKAI, K .
KIDNEY INTERNATIONAL, 1995, 47 (05) :1453-1457