Nephrol Dial Transplant (2002) 17: 1649-1654
© 2002 European Renal Association-European Dialysis and Transplant Association
CAHP-210 dialyzer influence on intra-dialytic vancomycin removal
1 Department of Pharmacy Practice, School of Pharmacy and Pharmacal Sciences, Purdue University, Indianapolis, USA and 2 Department of Medicine, School of Medicine, Indiana University, Indianapolis, USA
Background. Vancomycin is often administered during the last hour of haemodialysis because it was not removed significantly by older hemodialyzers. However, newer higher permeability hemodialyzers remove vancomycin, although the amount removed varies considerably between dialyzers. The purpose of this study was to determine the apparent amount of vancomycin removed during the last hour of haemodialysis with a CAHP-210 hemodialyzer.
Methods. Eight subjects with end-stage renal disease (ESRD) received i.v. vancomycin 15 mg/kg after their regular haemodialysis session ended. Serum samples for the determination of vancomycin concentrations were obtained serially for 44 h. After a 3-week washout, the study was repeated with the vancomycin infused during the last hour of their regular haemodialysis session using a CAHP-210 hemodialyzer. Vancomycin concentrations were determined by the Enzyme Multiplied Immunoassay Technique. Differential equations describing a two-compartment open infusion model were fitted to the serum concentration vs time data and pharmacokinetic parameters and apparent vancomycin removal was estimated.
Results. The median age and weight of the subjects were 52 years (range 37–71) and 75.6 kg (range 37.6–89.8), respectively. The apparent vancomycin intra-dialytic removal was 0.24 (range -0.07–0.35), which was statistically significantly different from zero.
Conclusions. Vancomycin administered during the last hour of CAHP-210 dialysis results in 24% less vancomycin exposure than when administered post-haemodialysis. This intra-dialytic drug loss should be accounted for when dosing vancomycin in this manner.
Keywords: antibiotics; biocompatible membrane; cellulose acetate; cellulose acetate high performance-210; cross-over study; drug removal; end-stage renal disease; glycopeptide; haemodialysis; hemodialyzer; human; pharmacokinetics; prospective study; vancomycin
Correspondence and offprint requests to: Kevin M. Sowinski, Purdue University, Department of Pharmacy Practice, D711 Myers Building, WHS, 1001 West 10th Street, Indianapolis, IN, 46202-2879, USA. Email: ksowinsk{at}iupui.edu
Present address: 
College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA.
Presented in part at the Annual Meeting of the American College of Clinical Pharmacy, Los Angeles, CA, November 1999.
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