Pharmacokinetics of vancomycin in patients with different renal function levels

Zarić, Radica Živković; Milovanović, Jasmina R.; Rosic, Nikola; Мilоvаnоvić, Drаgаn; Zečević, Dejana Ružić; Folić, Marko; Janković, Slobodan

doi:10.1515/med-2018-0068

Cited by 14 publications

(11 citation statements)

References 28 publications

(33 reference statements)

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“…However, to the best of our knowledge, the PPK model of vancomycin for Chinese infants based on different levels of renal function has not been proposed before. Zaric et al established a PPK model of vancomycin for adult patients with different renal function levels in 2018 ( 19 ), but this method has not been investigated among Chinese infants yet. So this study was the first one to conduct such an attempt.…”

Section: Discussionmentioning

confidence: 99%

Population Pharmacokinetics Modeling of Vancomycin Among Chinese Infants With Normal and Augmented Renal Function

et al. 2021

Front. Pediatr.

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There have been good amounts of population pharmacokinetics (PPK) models of vancomycin for Chinese pediatric patients, but none of them had a special focus on modeling infant population with different levels of renal function. Since renal function variability is prominent among infant population and the clearance (CL) of vancomycin is heavily related to renal excretion, it is important to establish precise PPK models based on individual renal function levels. We employed a PPK approach to develop three models of vancomycin in parallel for Chinese pediatric patients with normal renal function [estimated glomerular filtration rate (eGFR) between 30 and 86 ml/min/1.73 m2, Model 1], with augmented renal function (eGFR ≥ 86 ml/min/1.73 m2, Model 2), or with all levels of renal function (Model 3). Three one-compartment models with first-order elimination kinetics were established. The predictive ability of Model 1 and Model 2 among each certain population is comparable with that of Model 3 with no statistical difference. Our study revealed that among the infant population with augmented renal function, only body weight was included as a covariate, which indicated that for an infant whose eGFR ≥ 86 ml/min/1.73 m2, taking blood sample is not compulsory for predicting vancomycin blood concentration, which avoids unnecessary injury to vulnerable infants.

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Section: Discussionmentioning

confidence: 99%

Population Pharmacokinetics Modeling of Vancomycin Among Chinese Infants With Normal and Augmented Renal Function

et al. 2021

Front. Pediatr.

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“…The removal of drugs less dialysable in HD requires the administration of antidotes or other techniques of blood purification, such as hemodiafiltration, plasma exchange, or plasma absorption (13). VCM has a relatively high molecular weight of 1,450 g/mol, protein binding of approximately 10%-50%, low Vd of approximately 0.4-1.0 L/kg, and high water solubility, while CFPM has a relatively low molecular weight of 571.5 g/mol, protein binding of approximately 16%-19%, low Vd of approximately 0.2 L/kg, and high water solubility (5)(6)(7)14). VCM was estimated to have a lower removal efficiency in HD than CFPM, as its molecular weight was higher than that of CFPM, although both drugs have low protein binding, low Vd, and high water solubility.…”

Section: Discussionmentioning

confidence: 99%

“…The pharmacokinetic characteristics of VCM are an approximately 80-90% excretion via urine, with a volume of distribution (Vd) of approximately 0.4-1.0 L/kg. In contrast, approximately 80% of CFPM is excreted via the urine, with a Vd of approximately 0.2 L/kg ( 5 - 7 ). VCM and CFPM were presumed to have a high transferability to ascites, since the ascitic concentrations of these drugs were increased after intravenous administration in patients with peritoneal dialysis and abdominal surgery ( 8 - 10 ), and the intravenous administration of these drugs was effective against peritonitis in peritoneal dialysis patients and spontaneous bacterial peritonitis in liver cirrhosis patients ( 11 , 12 ).…”

Section: Discussionmentioning

confidence: 99%

Vancomycin Intoxication and Cefepime-induced Encephalopathy Treated by Abdominal Drainage of Massive Ascites in Addition to Online Hemodiafiltration

et al. 2021

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A patient with recurrent plasmacytoma with massive ascites exhibited vancomycin intoxication and cefepime-induced encephalopathy due to renal dysfunction. The ascitic accumulation of these drugs was suspected because of the refractory intoxicated state. To remove these drugs that had accumulated in the blood and ascites, abdominal drainage was performed in addition to online hemodiafiltration. If patients with renal dysfunction and massive ascites develop vancomycin intoxication and cefepime-induced encephalopathy that cannot be improved by drug discontinuation, physicians should suspect ascitic accumulation and evaluate the ascitic concentration. Furthermore, if a high accumulation in massive ascites occurs, physicians should perform abdominal drainage along with blood purification.

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“…52,53 Renal excretion was reported to be 89% in healthy volunteers by Golper et al 45 Vancomycin is reabsorbed from kidney tubules by megalin receptors. 54,55 Drug interaction studies in rat showed lack of interaction with probenecid (OAT1) and nonsignificant interactions with cimetidine (MATEs and OCT2) and quinidine (P-glycoprotein). 56 In rabbit kidney tubules, vancomycin is actively secreted.…”

Section: Discussionmentioning

confidence: 99%

Does “Birth” as an Event Impact Maturation Trajectory of Renal Clearance via Glomerular Filtration? Reexamining Data in Preterm and Full‐Term Neonates by Avoiding the Creatinine Bias

Salem

Johnson

Hodgkinson

et al. 2020

The Journal of Clinical Pharma

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Glomerular filtration rate (GFR) is an important measure of renal function. Various models for its maturation have recently been compared; however, these have used markers, which are subject to different renal elimination processes. Inulin clearance data (a purer probe of GFR) collected from the literature were used to determine age-related changes in GFR aspects of renal drug excretion in pediatrics. An ontogeny model was derived using a best-fit model with various combinations of covariates such as postnatal age, gestational age at birth, and body weight. The model was applied to the prediction of systemic clearance of amikacin, gentamicin, vancomycin, and gadobutrol. During neonatal life, GFR increased as a function of both gestational age at birth and postnatal age, hence implying an impact of birth and a discrepancy in GFR for neonates with the same postmenstrual age depending on gestational age at birth (ie, neonates who were outside the womb longer had higher GFR, on average). The difference in GFR between pre-term and full-term neonates with the same postmenstrual age was negligible from beyond 1.25 years. Considering both postnatal age and gestational age at birth in GFR ontogeny models is important because postmenstrual age alone ignores the impact of birth. Most GFR models use covariates of body size in addition to age. Therefore, prediction from these models will also depend on the change in anthropometric characteristics with age. The latter may not be similar in various ethnic groups, and this makes the head-to-head comparison of models very challenging.

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Pharmacokinetics of vancomycin in patients with different renal function levels

Cited by 14 publications

References 28 publications

Population Pharmacokinetics Modeling of Vancomycin Among Chinese Infants With Normal and Augmented Renal Function

Population Pharmacokinetics Modeling of Vancomycin Among Chinese Infants With Normal and Augmented Renal Function

Vancomycin Intoxication and Cefepime-induced Encephalopathy Treated by Abdominal Drainage of Massive Ascites in Addition to Online Hemodiafiltration

Does “Birth” as an Event Impact Maturation Trajectory of Renal Clearance via Glomerular Filtration? Reexamining Data in Preterm and Full‐Term Neonates by Avoiding the Creatinine Bias

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