Urea kinetics and dialysis treatment time predict vancomycin elimination during high-flux hemodialysis
- PMID: 9465839
- DOI: 10.1016/S0009-9236(98)90118-7
Urea kinetics and dialysis treatment time predict vancomycin elimination during high-flux hemodialysis
Abstract
Background: Hemodialysis sessions with high-flux filters ask for a reconsideration of the kinetics of xenobiotics. The aim of this study was to analyze whether individual high-flux hemodialysis treatment parameters are of predictive value for dosing guidelines, with use of vancomycin as a model compound.
Methods: Twenty-six patients receiving high-flux hemodialysis were studied prospectively. After an intravenous infusion of 1000 mg or 500 mg vancomycin, respectively, six to eight blood samples were collected within a period of 5 to 9 days, including one hemodialysis session. Serum vancomycin concentrations were measured by HPLC. Nonlinear mixed-effects modeling (NONMEM) was used to fit a two-compartment population pharmacokinetic model to the data of 20 patients; the data of the remaining six patients (group II) were used for a prospective evaluation of the model.
Results: A linear relationship was found between vancomycin filter clearance (CLDV) and urea filter clearance (CLDBUN), derived from Kt/V (the product of urea clearance [K] and dialysis treatment time [t], standardized for the urea volume of distribution [V]). Mean (coefficient of variation) steady-state volume of distribution was 1.05 L/kg (22%), CLDV was 0.336.CLDBUN (13%), and residual interdialytic clearance was 2.25 ml/min (90%) in patients with creatinine clearance values (CLCR) below 2 ml/min and 2.25 ml/min + 0.59.CLCR (32%) in patients with CLCR values above 2 ml/min. The model predicted predialysis vancomycin concentrations before the first and the second postinfusion dialysis session in the six patients of group II, with a deviation of 1.8 +/- 1.0 mg/L and 0.8 +/- 0.5 mg/L, respectively.
Conclusion: The described population pharmacokinetic model allows individualization of vancomycin dosing intervals in patients receiving hemodialysis, based on patient characteristics and urea kinetic modeling.
Similar articles
-
Pharmacokinetics of vancomycin when administered during high flux hemodialysis.Clin Nephrol. 1998 Jul;50(1):51-5. Clin Nephrol. 1998. PMID: 9710347 Clinical Trial.
-
Clearance of vancomycin during high-efficiency hemodialysis.J Med Assoc Thai. 2006 Jul;89(7):986-91. J Med Assoc Thai. 2006. PMID: 16881431
-
Adequacy of a vancomycin dosing regimen in patients receiving high-flux hemodialysis.Am J Kidney Dis. 2005 Oct;46(4):681-7. doi: 10.1053/j.ajkd.2005.07.018. Am J Kidney Dis. 2005. PMID: 16183423
-
Adequacy in dialysis: intermittent versus continuous therapies.Nefrologia. 2000;20 Suppl 3:25-32. Nefrologia. 2000. PMID: 10835874 Review.
-
Vancomycin dosing in patients on intermittent hemodialysis.Semin Dial. 2011 Jan-Feb;24(1):50-5. doi: 10.1111/j.1525-139X.2010.00803.x. Semin Dial. 2011. PMID: 21338394 Review.
Cited by
-
Clinical review: use of vancomycin in haemodialysis patients.Crit Care. 2002 Aug;6(4):313-6. doi: 10.1186/cc1516. Epub 2002 Jun 10. Crit Care. 2002. PMID: 12225605 Free PMC article. Review.
-
Vancomycin Sequestration in ST Filters: An In Vitro Study.Antibiotics (Basel). 2023 Mar 21;12(3):620. doi: 10.3390/antibiotics12030620. Antibiotics (Basel). 2023. PMID: 36978488 Free PMC article.
-
Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations.Pharmacol Res Perspect. 2018 Jul;6(4):e00420. doi: 10.1002/prp2.420. Pharmacol Res Perspect. 2018. PMID: 30156005 Free PMC article.
-
Model-Informed Precision Dosing of Vancomycin in Adult Patients Undergoing Hemodialysis.Antimicrob Agents Chemother. 2023 Jun 15;67(6):e0008923. doi: 10.1128/aac.00089-23. Epub 2023 May 17. Antimicrob Agents Chemother. 2023. PMID: 37195225 Free PMC article.
-
Vancomycin Population Pharmacokinetic Models in Non- Critically Ill Adults Patients: a scoping review.F1000Res. 2025 Mar 6;11:1513. doi: 10.12688/f1000research.128260.2. eCollection 2022. F1000Res. 2025. PMID: 40124851 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical