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. 2025 Mar 26;15(1):42.
doi: 10.1186/s13613-025-01461-z.

Amikacin use in critically ill patients requiring renal replacement therapy: the AMIDIAL-ICU study

Vincent Dupont #  1   2 , Bruno Mourvillier #  3   4 , Coralie Barbe  4 , Vincent Legros  3 , Mathieu Jozwiak  5 , Hamid Merdji  6 , Claire Dupuis  7 , Hadrien Winiszewski  8 , Antoine Marchalot  9 , Guillaume Lacave  10 , Mathilde Neuville  11 , Anne Sagnier  12 , François Barbier  13 , Carine Thivilier  14 , Stéphanie Ruiz  15 , Roland Smonig  16 , Jeremy Rosman  17 , Laurent Argaud  18 , Steven Grangé  19 , Benjamine Sarton  15 , Patrick Chillet  20 , Guillaume Voiriot  21 , Lukshe Kanagaratnam  3   4 , Zoubir Djerada  3   4
Affiliations

Amikacin use in critically ill patients requiring renal replacement therapy: the AMIDIAL-ICU study

Vincent Dupont et al. Ann Intensive Care. .

Abstract

Background: Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is common in intensive care units (ICUs), yet optimal amikacin dosing in this context remains poorly understood.

Methods: We conducted a prospective observational study across 18 French hospitals from April 2020 to January 2022. Adult ICU patients (aged > 18 years) receiving their first amikacin dose while on RRT were included. Data on demographics, RRT modalities, amikacin dosing, and therapeutic drug monitoring were collected. Using a pharmacokinetic modeling approach, we evaluated various amikacin regimens and simulated target attainment probabilities across different minimum inhibitory concentrations (MICs).

Results: A total of 111 patients were included, with approximately two-thirds receiving continuous RRT. The median amikacin dose was 27 (25-30) mg/kg. Amikacin peak (Cmax) and trough concentrations were monitored in 53 (47.8%) and 76 (68.5%) patients, respectively. Continuous RRT and a history of chronic kidney disease reduced dialytic clearance. For a MIC ≤ 4 mg/L, a 15 mg/kg amikacin dose achieved Cmax/MIC and AUC/MIC targets in ≥ 90% of patients on intermittent dialysis, while 20 mg/kg was required for those on continuous dialysis. For a MIC = 8 mg/L, a 30 mg/kg dose was necessary to achieve Cmax/MIC ≥ 8.

Conclusions: Our findings highlight suboptimal adherence to amikacin monitoring guidelines in ICU patients on RRT. Using pharmacokinetic modeling, we identified amikacin dosing recommendations ranging from 15 to 35 mg/kg to optimize efficacy and minimize risks, depending on MIC and dialysis modality.

Keywords: Amikacin; Aminoglycoside; Intensive care unit; Pharmacokinetic; Renal replacement therapy.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All subjects or their representatives provided informed consent to enroll. This study was approved by the ethics committee (CPP Sud Ouest et Outremer 2, 2020) and was registered on CinicalTrials.gov (NCT04322019). Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Probabilities of amikacin pharmacokinetic targets achievement in critically ill patients undergoing renal replacement therapy using total body weight. The probabilities to achieve a maximum concentration (Cmax) / minimum inhibitory concentration (MIC) ratio > 8, an area under the curve (AUC) within the first 24 h / MIC > 75 and a minimum concentration < 2.5 mg/L at 24-48-72 h in patients with a history of chronic kidney disease (CKD) treated with continuous (A) or intermittent (B) dialysis and patients without history of CKD treated with continuous (C) or intermittent (D) dialysis are depicted, based on Monte Carlo simulation
See this image and copyright information in PMC

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