Contribution of diafiltration and adsorption to vancomycin clearance in a continuous hemodiafiltration circuit model in vitro

Uchida, Masashi; Sawada, Mifuyu; Yamazaki, Shingo; Suzuki, Tatsuya; Suzuki, Takaaki; Ishii, Itsuko

doi:10.1111/aor.14178

Cited by 3 publications

(2 citation statements)

References 35 publications

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“…Additionally, adsorption is inversely correlated to effluent flow rate and, in the case of amikacin, results in a 17% decrease in adsorption rate per 1 L/min increase in the flow rate 33,34 . For vancomycin, adsorption seems lower, ranging from 4% to 12% 62 . Consequently, clinicians should be aware of the risk of underexposure when polyacrylonitrile filters are used, especially for aminoglycosides.…”

Section: Antimicrobial Dosing With Renal Replacement Therapymentioning

confidence: 99%

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Practical considerations for individualizing drug dosing in critically ill adults receiving renal replacement therapy

et al. 2023

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Critically ill patients with sepsis admitted to the intensive care unit (ICU) often present with or develop renal dysfunction requiring renal replacement therapy (RRT) in addition to antimicrobial therapy. While early and appropriate antimicrobials for sepsis have been associated with an increased probability of survival, adequate dosing is also required in these patients. Adequate dosing of antimicrobials refers to dosing strategies that achieve serum drug levels at the site of infection that are able to provide a microbiological and/or clinical response while avoiding toxicity from excessive antibiotic exposure. Therapeutic drug monitoring (TDM) is the recommended strategy to achieve this goal, however, TDM is not routinely available in all ICUs and for all antimicrobials. In the absence of TDM, clinicians are therefore required to make dosing decisions based on the clinical condition of the patient, the causative organism, the characteristics of RRT, and an understanding of the physicochemical properties of the antimicrobial. Pharmacokinetics (PK) of antimicrobials can be highly variable between critically ill patients and also within the same patient over the course of their ICU stay. The initiation of RRT, which can be in the form of intermittent hemodialysis, continuous, or prolonged intermittent therapy, further complicates the predictability of drug disposition. This variability highlights the need for individualized dosing. This review highlights the practical considerations for the clinician for antimicrobial dosing in critically ill patients receiving RRT.

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Section: Antimicrobial Dosing With Renal Replacement Therapymentioning

confidence: 99%

“…33,34 For vancomycin, adsorption seems lower, ranging from 4% to 12%. 62 Consequently, clinicians should be aware of the risk of underexposure when polyacrylonitrile filters are used, especially for aminoglycosides. TDMbased dosing or at least increased dosing should be considered.…”

Section: Type Of Membranes/adsorptionmentioning

confidence: 99%

Practical considerations for individualizing drug dosing in critically ill adults receiving renal replacement therapy

et al. 2023

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In vitro effects of anti-MRSA agent adsorption onto the AN69ST hemofilter

Inano,

Tsuchiya,

Kumano

et al. 2024

Ren Replace Ther

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Background Blood purification therapy with a sulfonated polyacrylonitrile surface treated (AN69ST) hemofilter is used to treat sepsis. However, the AN69ST hemofilter has been reported to adsorb and remove therapeutic drugs; warranting further investigation. In this study, we evaluated the adsorption effects of AN69ST membranes and hemofilters connected to a dialysis circuit model on anti-methicillin-resistant Staphylococcus aureus (anti-MRSA) agents, such as arbekacin sulfate (ABK), linezolid (LZD), vancomycin hydrochloride (VCM), teicoplanin (TEIC), and daptomycin (DAP), in in vitro experiments. Methods Drug solutions were exposed to AN69ST membranes. The absorbance of the drug solution was measured over time, and the drug content was calculated. Additionally, we calculated the drug content over time by circulating the drug solution through a dialysis circuit model. The clearance of each drug was determined at 5 and 60 min. Results The content of ABK, TEIC, DAP, and VCM decreased substantially after the addition of AN69ST membranes compared to those of the standard reagent. However, the LZD content did not decrease. In the dialysis circuit model, the content of ABK, TEIC, DAP, and VCM were 3.7%, 25.7%, 43.8%, and 44.5%, respectively, at 20 min, which were clearly lower than those of the standard reagent (62–64%). However, the LZD content remained unchanged. The clearance of ABK, TEIC, DAP, and VCM increased after 5 min. Conclusions The in vitro adsorption of anti-MRSA agents onto the AN69ST hemofilter was confirmed for ABK, TEIC, DAP, and VCM. Positively charged ABK was particularly susceptible to adsorption and should be avoided during blood purification using the AN69ST hemofilter. In addition, we concluded that TEIC, DAP, and VCM should be used for therapeutic drug monitoring because the adsorption rate of each drug is believed to vary depending on its protein binding rate.

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Contribution of Adsorption and Hematocrit Levels to Ganciclovir Clearance in an <i>in Vitro</i> Continuous Hemodiafiltration Model

Roongpairoj,

Uchida,

Yamazaki

et al. 2024

Biological & Pharmaceutical Bulletin

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Estimation of the continuous hemodiafiltration (CHDF) clearance (CL CHDF ) of ganciclovir (GCV) is crucial for achieving efficient treatment outcomes. Here, we aimed to clarify the contribution of diafiltration, adsorption, and hematocrit level to the CL CHDF of GCV in an in vitro CHDF model using three membranes: polyacrylonitrile and sodium methallyl sulfonate copolymer coated with polyethylenimine (AN69ST); polymethylmethacrylate (PMMA); and polysulfone (PS). In vitro CHDF was performed with effluent flow rates (Qe) of 800, 1500, and 3000 mL/h. The initial GCV concentration was 10 µg/mL while that of human serum albumin (HSA) was 0 or 5 g/dL. The CL CHDF , diafiltration rates, and adsorption rates were calculated. The whole blood-to-plasma ratio (R) of GCV for a hematocrit of 0.1 to 0.5 was determined using blood samples with 0.5 to 100 µg/mL of GCV. The in vitro CHDF experiment using AN69ST, PMMA, and PS membranes showed that the total CL CHDF values were almost the same as the Qe and not influenced by the HSA concentration. The diafiltration rate exceeded 88.1 2.8% while the adsorption rate was lower than 9.4 9.4% in all conditions. The R value was 1.89 0.11 and was similar at all hematocrit levels and GCV concentrations. In conclusion, diafiltration mainly contributes to the CL CHDF of GCV, rather than adsorption. Hematocrit levels might not affect the relationship between the plasma and blood CL CHDF of GCV, and the CL CHDF of GCV can be estimated from the Qe and R, at least in vitro.

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Contribution of diafiltration and adsorption to vancomycin clearance in a continuous hemodiafiltration circuit model in vitro

Cited by 3 publications

References 35 publications

Practical considerations for individualizing drug dosing in critically ill adults receiving renal replacement therapy

Practical considerations for individualizing drug dosing in critically ill adults receiving renal replacement therapy

In vitro effects of anti-MRSA agent adsorption onto the AN69ST hemofilter

Contribution of Adsorption and Hematocrit Levels to Ganciclovir Clearance in an <i>in Vitro</i> Continuous Hemodiafiltration Model

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