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NDT Advance Access originally published online on February 27, 2006
Nephrology Dialysis Transplantation 2006 21(5):1402-1406; doi:10.1093/ndt/gfl048
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Brief Report

Does haemodialysis significantly affect serum linezolid concentrations in critically ill patients with renal failure? A pilot investigation

Enrico Fiaccadori, Umberto Maggiore, Carlo Rotelli, Roberto Giacosa, Elisabetta Parenti, Edoardo Picetti1, Paola Manini, Roberta Andreoli and Aderville Cabassi

Terapia Intensiva, Dipartimento di Clinica Medica, Nefrologia & Scienze della Prevenzione, Università degli Studi di Parma and 1 Servizio di Anestesia e Rianimazione, Azienda Ospedaliera – Universitaria, Parma, Italy

Correspondence and offprint requests to: Enrico Fiaccadori, MD, PhD, Terapia Intensiva, Dipartimento di Clinica Medica, Nefrologia & Scienze della Prevenzione, Università degli Studi di Parma, Via Gramsci 14–43100 Parma, Italy. Email: enrico.fiaccadori{at}unipr.it

Background. Previous studies have shown that a single haemodialysis (HD) session removes about one-third of the linezolid dose administered, but it is unknown whether in critically ill patients with renal failure on intermittent HD, this removal adversely affects serum antibiotic concentrations.

Methods. Five male critically ill patients (mean age 75 years, range 68–82; APACHE II score 26.4, range 23–29; survival 2/5) with sepsis and renal failure on haemodialysis, were administered i.v. linezolid, 600 mg every 12 h. Serum antibiotic levels were measured by high-performance liquid chromatography/mass spectrometry. We classified trough concentrations as ‘with HD’ when a HD session was performed after linezolid infusion, and ‘without HD’ otherwise. We also computed population pharmacokinetics while patients were on-dialysis and off-dialysis.

Results. A total of 222 serum linezolid concentrations were available over 36 days of antibiotic therapy, during which patients underwent 31 HD sessions. Trough serum linezolid levels averaged 5.83 mg/l (range 1.48–15.84), exceeding 4.0 mg/l in 68.9% of the samples; however, the trough levels ‘with HD’ were lower than those ‘without HD’ (4.68 mg/l [range 1.48–9.07] vs 6.74 mg/l [range 2.04–15.84], P<0.001). Clearance and half-life were 6.0 l/h and 4.0 h, respectively, while patients were on-dialysis, and 4.4 l/h and 7.3 h, respectively, when they were off-dialysis.

Conclusions. HD can significantly reduce serum linezolid levels in critically ill patients with renal failure.

Keywords: critical illness; dosage guidelines; haemodialysis; linezolid; renal failure


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