Nephrology Dialysis Transplantation, Vol 12, Issue 12 2647-2653, Copyright © 1997 by Oxford University Press
M Scott, B Mueller and W Clark
Background: In comparison to conventional
haemodialysis membranes, highly permeable membranes allow a broader
spectrum of solute removal, including enhanced elimination of vancomycin
(1448 Daltons). However, the mass transfer characteristics of vancomycin
removal by highly permeable membranes have not been adequately assessed. An
understanding of vancomycin's predominant dialytic mass transfer mechanism
under a given set of operating conditions, including dialyser type and flow
rates, may permit more accurate dosing of the drug.
Methods: We performed a mass transfer analysis of
vancomycin removal by a high-flux dialyser, cellulose triacetate (CT). In a
cross-over fashion with a 3-week washout between treatments, eight subjects
received vancomycin 1000 mg (1) during the last hour of CT haemodialysis;
or (2) after dialysis. Serial urea and vancomycin serum concentrations were
used to assess dialytic removal. Results: Dialysis
removed 26.2% (mean; range 16-44%) of the administered vancomycin dose.
While vancomycin removal and (Kt/)urea were directly correlated (r=0.88; P
<0.005), no correlation was observed between vancomycin removal and
weight-normalized ultrafiltration rate. Conclusions:
These findings suggest that for the CT dialyser and dialysis operating
conditions employed in this study, vancomycin clearance was primarily
mediated by diffusion. As such, these data challenge the general concept
that convection is primarily responsible for the removal of solutes in the
same molecular weight class as vancomycin during high-flux dialysis.
Key words: convection; diffusion; haemodialyser;
pharmacokinetics; vancomycin
ORIGINAL ARTICLES
Vancomycin mass transfer characteristics of high-flux cellulosic dialysers
Department of Pharmacy Practice, School of Pharmacy and Pharmacal Sciences, Purdue University, West Lafayette, IN, USA; Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA; Corresponding author at: Renal Division, Baxter Healthcare Corporation, 1620 Waukegan Road; MPR-31, McGaw Park, IL 60085, USA
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