Vancomycin pharmacokinetics in patients treated with intermittent haemodialysis based on therapeutic drug monitoring

Hartinger, Jan Miroslav; Šíma, Martin; Hronová, Karolína; Halouzková, Barbora Agátha; Szonowská, Barbora; Polakovič, Vladimír; Bednářová, Vladimíra; Hladinova, Zuzana; Tesař, Vladimı́r; Slanař, Ondřej

doi:10.1080/1120009x.2021.1979747

Cited by 6 publications

(4 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This dosage regimen was introduced before the PK, and pharmacodynamic properties of AGs were known in detail. The CL of AGs during dialysis resembles the renal CL of patients with normal renal functions [53], and in a similar way to other antibiotics [54], a part of the administered dose is eliminated before it is distributed into the tissues when administered during dialysis. The elimination of AG is very slow during the inter-dialysis period and varies considerably.…”

Section: Timing Of Administration Of Ag In Patients Treated With Ihd ...mentioning

confidence: 99%

Dosing of Aminoglycosides in Chronic Kidney Disease and End-Stage Renal Disease Patients Treated with Intermittent Hemodialysis

Halouzková

Hartinger

Krátký

et al. 2022

Kidney Blood Press Res

Self Cite

View full text Add to dashboard Cite

Background: The dosing of aminoglycosides (AGs) in patients with kidney disease is challenging due to their markedly prolonged half-life, which renders pulse dosing schedules unsuitable. We performed a review of the literature that describes the pharmacokinetics of, and dosing recommendations for, AG for patients with abnormal renal functions and various renal replacement therapy modalities, focusing on patients treated with intermittent hemodialysis (iHD). Summary: During one iHD session, dialysis removes a remarkable amount of the drug regardless of the dialyzer type. In patients with severely reduced kidney functions, the distribution phase is prolonged, which needs to be taken into account when drawing samples shortly after drug administration or following an iHD session. Key Messages: The doses recommended for the pulse dosing of patients without kidney disease leads to unacceptably high overall systemic exposure for patients with severely reduced kidney functions even with dosing intervals extended up to 48 h. Therefore, lower doses accompanied by extended dosing intervals must be applied for this patient group. The clinical evidence and current recommendations support the dosing of AG following, rather than before, HD sessions. In patients with end-stage kidney disease, the samples for TDM of AGs should not be drawn earlier than 2 h after end of the infusion and 4 h after the end of iHD session to allow full (re)distribution of the drug.

show abstract

Section: Timing Of Administration Of Ag In Patients Treated With Ihd ...mentioning

confidence: 99%

Dosing of Aminoglycosides in Chronic Kidney Disease and End-Stage Renal Disease Patients Treated with Intermittent Hemodialysis

Halouzková

Hartinger

Krátký

et al. 2022

Kidney Blood Press Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…On the other hand, the diffusion of vancomycin from the blood into the peritoneal dialysate occurs when the drug concentrations in plasma are higher than in the peritoneal cavity [ 5 , 6 ]. The systemic pharmacokinetics of vancomycin in patients with end-stage renal disease (ESRD) is markedly altered due to a diminished clearance (CL) [ 8 , 9 ]. Nevertheless, systemic CL of vancomycin persists to some extent in patients with residual kidney function compared to anuric patients [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Intraperitoneally Administered Vancomycin in Patients with Peritoneal Dialysis-Associated Peritonitis: Population Pharmacokinetics and Dosing Implications

et al. 2023

Self Cite

View full text Add to dashboard Cite

Peritonitis is a limiting complication of peritoneal dialysis, which is treated by intraperitoneal administration of antibiotics. Various dosing strategies are recommended for intraperitoneally administered vancomycin, which leads to large differences in intraperitoneal vancomycin exposure. Based on data from therapeutic drug monitoring, we developed the first-ever population pharmacokinetic model for intraperitoneally administered vancomycin to evaluate intraperitoneal and plasma exposure after dosing schedules recommended by the International Society for Peritoneal Dialysis. According to our model, currently recommended dosing schedules lead to possible underdosing of a large proportion of patients. To prevent this, we suggest avoiding intermittent intraperitoneal vancomycin administration, and for the continuous dosing regimen, we suggest a loading dose of 20 mg/kg followed by maintenance doses of 50 mg/L in each dwell to improve the intraperitoneal exposure. Vancomycin plasma level measurement on the fifth day of treatment with subsequent dose adjustment would prevent it from reaching toxic levels in the few patients who are susceptible to overdose.

show abstract

“…Furthermore, lowflux haemodialysis filters remain in clinical use prompting research and guidelines regarding optimal dosing with this modality. 3,[5][6][7] This study aims to determine the rate of attainment and maintenance for pre-dialysis vancomycin concentrations of 15-25 mg/L during low-flux HD from a non-weight-based dosing regimen used in our hospital. Furthermore, we assess if a one-or two-compartment model implemented in a commercially available pharmacokinetics platform utilizing Bayesian forecasting can adequately predict vancomycin serum concentrations and guide decision-making regarding vancomycin dosing in patients with KFRT treated with HD using a low-flux filter.…”

Section: Introductionmentioning

confidence: 99%

“…The effect of this change in filters on vancomycin therapy has not been confirmed. Furthermore, low‐flux haemodialysis filters remain in clinical use prompting research and guidelines regarding optimal dosing with this modality 3,5–7 …”

Section: Introductionmentioning

confidence: 99%

Optimizing the dosing of vancomycin in patients receiving intermittent haemodialysis with low‐flux filters, and the potential impact of dosing software

et al. 2023

View full text Add to dashboard Cite

AimIterative approaches to vancomycin dosing (e.g., dosing when trough concentrations <15–20 mg/L) can be inadequate. Computer‐guided dosing may be superior but has not been evaluated in patients with kidney failure receiving replacement therapy. We evaluated vancomycin concentrations using a hospital protocol and a pharmacokinetic software. We measured vancomycin clearance by the FX8 low‐flux filter because data are absent.MethodsWe retrospectively reviewed records of adults with kidney failure requiring replacement therapy receiving vancomycin and dialysed with the FX8 low‐flux filter, and calculated the proportion of pre‐dialysis concentrations that were within, above or below a specified range. One and two‐compartment models in the pharmacokinetic software were assessed by computing mean prediction error (MPE) and root mean square error (RMSE) of observed versus predicted concentrations. Vancomycin extracorporeal clearance was prospectively determined using the extraction method.ResultsIn 24 patients (34 courses; 139 paired observed and predicted concentrations), 62/139 (45%) pre‐dialysis concentrations were 15–25 mg/L, 29/139 (21%) were above, and 48/139 (35%) were below. MPE for the one‐compartment model was −0.2 mg/L, RMSE 5.3 mg/L. MPE for the two‐compartment model was 2.0 mg/L, RMSE 5.6 mg/L. Excluding the first paired concentrations, the subsequent MPE (n = 105) using one‐compartment model was −0.5 mg/L, RMSE 5.6 mg/L. The MPE for the two‐compartment model was 2.1 mg/L, RMSE 5.8 mg/L. The median extracorporeal clearance was 70.7 mL/min (range: 10.3–130.3; n = 22).ConclusionsVancomycin dosing was suboptimal and the pharmacokinetic software was not sufficiently predictive. These may improve with a loading dose. The substantial removal of vancomycin by low‐flux filters is not accounted for by the models tested.

show abstract

Vancomycin pharmacokinetics in patients treated with intermittent haemodialysis based on therapeutic drug monitoring

Cited by 6 publications

References 24 publications

Dosing of Aminoglycosides in Chronic Kidney Disease and End-Stage Renal Disease Patients Treated with Intermittent Hemodialysis

Dosing of Aminoglycosides in Chronic Kidney Disease and End-Stage Renal Disease Patients Treated with Intermittent Hemodialysis

Intraperitoneally Administered Vancomycin in Patients with Peritoneal Dialysis-Associated Peritonitis: Population Pharmacokinetics and Dosing Implications

Optimizing the dosing of vancomycin in patients receiving intermittent haemodialysis with low‐flux filters, and the potential impact of dosing software

Contact Info

Product

Resources

About