Vancomycin in peritoneal dialysis: Clinical pharmacology considerations in therapy

Lam, Edwin; Lien, Yi Ting Kayla; Kraft, Walter K.; Piraino, Beth; Vozmediano, Valvanera; Schmidt, Stephan; Zhang, Jingjing

doi:10.1177/0896860819889774

Cited by 21 publications

(23 citation statements)

References 46 publications

(85 reference statements)

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“…The development of coronary heart disease is linked to systemic atherosclerosis. Patients with elevated levels of medial calcification may provide insight into this phenomenon, so it is feasible to assess the hypothesis of death and prognosis of patients [ 9 – 11 ]. Thus, accurate determination of the degree of AS in patients or exploration of related biomarkers is of great importance for patient prognosis [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

The Correlation between Serum Sclerostin Level and Arterial Stiffness in Peritoneal Dialysis Patients

Liu¹,

Ma²,

Ma³

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To study the correlation between serum sclerostin (SO) and arterial stiffness in peritoneal dialysis (PD) patients. Methods. The study included 50 Parkinson’s disease (PD) patients on continuous ambulatory peritoneal dialysis (CAPD) for more than 6 months at the nephrology department of our hospital. Without regard for age, the eligible patients were assigned to a low PWV group and a high PWV group with brachial-ankle pulse wave velocity (Ba PWV) of 1400 cm/s as the cutoff value. Patient characteristics such as age, gender, height, weight, BMI, smoking history, dialysis age, systolic blood pressure (SBP), diastolic blood pressure (DBP), urea clearance index (Kt/V), residual renal function (RRF), and diabetes mellitus (DM) were analyzed. Biochemical indices for analysis include hemoglobin (Hb), albumin (ALB), total cholesterol (TC), urea nitrogen (BUN), creatinine (CREA), triglyceride (TG), uric acid (UA), parathyroid hormone (PTH), blood phosphorus(P), fasting blood glucose (GLU), corrective calcium (Ca), calcium-phosphorus product, low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), SO, and arterial stiffness. Results. There were 9 males and 16 females in the low PWV group and 12 males and 13 females in the high PWV group. Statistical significance was absent in patient characteristics despite more males in the high PWV group ( P = 0.055 ). The low PWV group had significantly lower mean age, SBP, SO, and PWV level, fewer diabetic patients, and higher CREA than the control group. Analysis of PWV-related factors showed that PWV was positively correlated with age, P, Ca, GLU, SBP, PTH, and SO while negatively correlated with CREA. Multiple stepwise regression analysis showed that age, SO, and SBP demonstrated great potential to predict PWV ( P < 0.05 ). Conclusion. The degree of vascular sclerosis is highly correlated with SO level in Parkinson’s disease patients, which might provide a theoretical basis for the evaluation of cardiovascular illness in Parkinson’s disease patients. High serum sclerostin level is a risk factor for deteriorated arterial stiffness. Given the limited sample size, the relevant results require further validation by expanding the sample size.

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Section: Introductionmentioning

confidence: 99%

The Correlation between Serum Sclerostin Level and Arterial Stiffness in Peritoneal Dialysis Patients

Liu¹,

Ma²,

Ma³

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…Pharmacokinetic and pharmacodynamics studies of drugs in the PD population are scarce and recommendations for treatment with IP antibiotics for patients with peritonitis are based on observational studies, mostly without monitoring serum and IP drug concentrations (Morse et al, 1987;Szeto et al, 2017;Lam et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

“…Despite the importance of the topic, the level of clinical evidence to correctly guide antibiotic treatment in patients with PD-related peritonitis is weak. The ISPD guidelines recommend that antibiotics preferably are administered intermittently or continuously via the IP route (Li et al, 2016;Szeto et al, 2017;Lam et al, 2020). When administered intermittently, in order to cure the infection, back-diffusion of the drug in the serum to the dialysate must occur during exchanges without the antibiotic (Johnson, 2011).…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics of Intraperitoneal Vancomycin and Amikacin in Automated Peritoneal Dialysis Patients With Peritonitis

et al. 2021

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Objective: The study aimed to evaluate the vancomycin and amikacin concentrations in serum and dialysate for automatic peritoneal dialysis (APD) patients.Methods: A total of 558 serum and dialysate samples of 12 episodes of gram-positive and 18 episodes of gram-negative peritonitis were included to investigate the relationship between vancomycin and amikacin concentrations in serum and dialysate on the first and third days of treatment. Samples were analysed 30, 120 min, and 48 h after intraperitoneal administration of vancomycin in peritonitis caused by gram-positive agents and 30, 120 min, and 24 h after intraperitoneal administration of amikacin in peritonitis caused by gram-negative agents. Vancomycin was administered every 72 h and amikacin once a day. The target therapeutic concentration of amikacin was 25–35 mg/l at the peak moment and 4–8 mg/l at the trough moment; and after 48 h for vancomycin, 15–20 mg/l at the trough moment.Results: For peritonitis caused by gram-negative agents, at the peak moment, therapeutic levels of amikacin were reached in dialysate in 80.7% of patients with evolution to cure and in 50% of patients evaluated as non-cure (p = 0.05). At the trough moment, only 38% were in therapeutic concentrations in the dialysate in the cure group and 42.8% in the non-cure group (p = 1). Peak plasma concentrations were subtherapeutic in 98.4% of the samples in the cure group and in 100% of the non-cure group. At the trough moment, therapeutic concentrations were present in 74.4% of the cure group and 71.4% of the non-cure group (p = 1). Regarding vancomycin and among gram-positive agents, therapeutic levels were reached at the peak moment in 94% of the cure group and 6% of the non-cure group (p = 0.007). After 48 h, 56.8% of the cure group had a therapeutic serum concentration whereas for the non-cure group it was only 33.3% (p = 0.39).Conclusion: Despite a small sample size, we demonstrated peak dialysate amikacin level and peak serum vancomycin level correlates well with Gram-negative and Gram positve peritonitis cure, respectively. It is suggested to study the antibiotics pharmacodynamics for a better understanding of therapeutic success in a larger sample.

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“…The rate of which vancomycin is absorbed is dependent on the peritoneal membrane. 6 During inflammatory peritonitis, the rate of absorption increases enhancing the rate of transfer from the peritoneum to systemic circulation. The enhanced rate of absorption may reduce the time required for complete absorption.…”

Section: Discussionmentioning

confidence: 99%

“…With the addition of the automated cycler in APD, overall drug disposition may be impacted due to the frequent number of dialytic exchanges. 6 We conducted a pilot observational pharmacokinetic study in patients on APD to characterize the vancomycin disposition in circulation, dialysis fluid, and urine. The study assessed the adequacy of vancomycin absorption following an extended drug-dialysis fluid dwell while estimating the pharmacokinetic parameters during the rapid exchanges.…”

Section: Introductionmentioning

confidence: 99%

Intraperitoneal pharmacokinetics of vancomycin in patients on automated peritoneal dialysis

Lam

Lien

Kraft

et al. 2021

Clinical Translational Sci

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It is unclear if the pharmacokinetics of vancomycin are the same during automated peritoneal dialysis (APD), where cycler exchanges may affect the systemic, peritoneal, and urinary disposition of drug. We conducted a prospective pharmacokinetic study evaluating the pharmacokinetics of vancomycin in plasma, dialysis fluid, and urine in peritonitis-negative patients on APD. Patients underwent four drug-free exchanges with 1.5% or 2.5% dextrose following the initial dwell period. Plasma, dialysis fluid, and urine was collected over the course of 7 days for pharmacokinetic analysis. Four patients completed the study with no adverse events. Following a median (range) dwell of 14.6 (14.2-17.6 h), the mean (±SD) observed maximum plasma concentration was 28.7 ± 4.9 mg/L with a mean bioavailability of 98.5 ± 1.4% prior to starting the cycler. The overall mean total plasma clearance estimated from study start to completion was 7.6 ± 1.2 ml/min. Mean total clearance during the dialytic exchange was 13.6 ± 4.9 ml/min. In patients with residual renal function, the mean vancomycin renal clearance was 3.1 ± 1.5 ml/min, representing 21.4%-58.9% of the overall total plasma clearance during the study period. Despite the small sample size, this pilot study suggests that the dwell time has important implications for systemic vancomycin exposure, time to therapeutic plasma concentration, and dosing. Dose is driven by dwell time, whereas the cycler determines the dosing interval. Rapid exchanges from APD will determine the frequency of dosing rather than the adequacy of absorption when vancomycin is given in the peritoneum. Study Highlights WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC?Vancomycin dosing in patients with peritonitis during automated peritoneal dialysis (APD) is empiric and extrapolated from studies in patients on continuous ambulatory peritoneal dialysis (CAPD). Extrapolation of pharmacokinetic data from CAPD to APD may result in substantial under-or overdosing due to rapid exchanges and longer dwell times. The impact of residual renal function on vancomycin pharmacokinetics is also unknown.

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Vancomycin in peritoneal dialysis: Clinical pharmacology considerations in therapy

Cited by 21 publications

References 46 publications

The Correlation between Serum Sclerostin Level and Arterial Stiffness in Peritoneal Dialysis Patients

The Correlation between Serum Sclerostin Level and Arterial Stiffness in Peritoneal Dialysis Patients

Pharmacokinetics of Intraperitoneal Vancomycin and Amikacin in Automated Peritoneal Dialysis Patients With Peritonitis

Intraperitoneal pharmacokinetics of vancomycin in patients on automated peritoneal dialysis

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