Influence of cellulose triacetate hemodialyzers on vancomycin pharmacokinetics.

Welage, Lynda S.; Mason, Nancy A.; Hoffman, Elyse J.; Odeh, Rudina M.; Dombrouski, Janet; Patel, Jayant A.; Swartz, Richard D.

doi:10.1681/asn.v641284

Cited by 23 publications

(2 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Transmembrane drug clearance in hemodialysis is a function of Qd and saturation coefficient (ratio of dialysate concentration to plasma concentration). Regression analyses were conducted using published data on transmembrane drug clearance and effluent flow rates to estimate saturation coefficients at various Qd in HHD [ 14 , 16 , 17 , 19 , 22 – 33 ]. The best fitting relationships were modeled to estimate saturation coefficient at the desired Qd in HHD.…”

Section: Methodsmentioning

confidence: 99%

Vancomycin and daptomycin dosing recommendations in patients receiving home hemodialysis using Monte Carlo simulation

Lewis,

Jang,

Mueller

2023

BMC Nephrol

View full text Add to dashboard Cite

Background Few drug dosing recommendations for patients receiving home hemodialysis (HHD) have been published which has hindered the adoption of HHD. HHD regimens vary widely and differ considerably from conventional, thrice weekly, in-center hemodialysis in terms of treatment frequency, duration and blood and dialysate flow rates. Consequently, vancomycin and daptomycin clearances in HHD are also likely to be different, consequently HHD dosing regimens must be developed to ensure efficacy and minimize toxicity when these antibiotics are used. Many HHD regimens are used clinically, this study modeled ten common HHD regimens and determined optimal vancomycin and daptomycin dosing for each HHD regimen. Methods Monte Carlo simulations using pharmacokinetic data derived from the literature and demographic data from a large HHD program treating patients with end stage kidney disease were incorporated into a one-compartment pharmacokinetic model. Virtual vancomycin and daptomycin doses were administered post-HHD and drug exposures were determined in 5,000 virtual patients receiving ten different HHD regimens. Serum concentration monitoring with subsequent dose changes was incorporated into the vancomycin models. Pharmacodynamic target attainment rates were determined for each studied dose. The lowest possible doses that met predefined targets in virtual patients were chosen as optimal doses. Results HHD frequency, total dialysate volumes and HHD durations influenced drug exposure and led to different dosing regimens to meet targets. Antibiotic dosing regimens were identified that could meet targets for 3- and 7-h HHD regimens occurring every other day or 4–5 days/week. HHD regimens with 3-day interdialytic periods required higher doses prior to the 3-day period. The addition of vancomycin serum concentration monitoring allowed for calculation of necessary dosing changes which increased the number of virtual subjects meeting pharmacodynamic targets. Conclusions Doses of vancomycin and daptomycin that will meet desired pharmacodynamic targets in HHD are dependent on patient and HHD-specific factors. Doses used in conventional thrice weekly hemodialysis are unlikely to meet treatment goals. The antibiotic regimens paired with the HHD parameters studied in this analysis are likely to meet goals but require clinical validation.

show abstract

Section: Methodsmentioning

confidence: 99%

Vancomycin and daptomycin dosing recommendations in patients receiving home hemodialysis using Monte Carlo simulation

Lewis,

Jang,

Mueller

2023

BMC Nephrol

View full text Add to dashboard Cite

show abstract

“…Transmembrane drug clearance in hemodialysis is a function of Qd and saturation coe cient (ratio of dialysate concentration to plasma concentration). Regression analyses were conducted using published data on transmembrane drug clearance and e uent ow rates to estimate saturation coe cients at various Qd in HHD [14-16, 19,[22][23][24][25][26][27][28][29][30][31][32][33]. The best tting relationships were modeled to estimate saturation coe cient at the desired Qd in HHD.…”

Section: Development Of Pharmacokinetic Modelsmentioning

confidence: 99%

Vancomycin and Daptomycin Dosing Recommendations in Patients Receiving Home Hemodialysis Using Monte Carlo Simulation

Lewis

Jang

Mueller

2023

Preprint

View full text Add to dashboard Cite

Background: Few drug dosing recommendations for patients receiving home hemodialysis (HHD) have been published which has hindered the adoption of HHD. HHD regimens vary widely and differ considerably from conventional, thrice weekly, in-center hemodialysis in terms of treatment frequency, duration and blood and dialysate flow rates. Consequently, vancomycin and daptomycin clearances in HHD are also likely to be different, consequently HHD dosing regimens must be developed to ensure efficacy and minimize toxicity when these antibiotics are used. Many HHD regimens are used clinically, this study modeled ten common HHD regimens and determined optimal vancomycin and daptomycin dosing for each HHD regimen. Methods: Monte Carlo simulations using pharmacokinetic data derived from the literature and demographic data from a large HHD program treating patients with end stage kidney disease were incorporated into a one-compartment pharmacokinetic model. Virtual vancomycin and daptomycin doses were administered post-HHD and drug exposures were determined in 5,000 virtual patients receiving ten different HHD regimens. Serum concentration monitoring with subsequent dose changes was incorporated into the vancomycin models. Pharmacodynamic target attainment rates were determined for each studied dose. The lowest possible doses that met predefined targets in virtual patients were chosen as optimal doses. Results: HHD frequency, total dialysate volumes and HHD durations influenced drug exposure and led to different dosing regimens to meet targets. Antibiotic dosing regimens were identified that could meet targets for 3- and 7-hour HHD regimens occurring every other day or 4-5 days/week. HHD regimens with 3-day interdialytic periods required higher doses prior to the 3-day period. The addition of vancomycin serum concentration monitoring allowed for calculation of necessary dosing changes which increased the number of virtual subjects meeting pharmacodynamic targets. Conclusions: Doses of vancomycin and daptomycin that will meet desired pharmacodynamic targets in HHD are dependent on patient and HHD-specific factors. Doses used in conventional thrice weekly hemodialysis are unlikely to meet treatment goals. The antibiotic regimens paired with the HHD parameters studied in this analysis are likely to meet goals but require clinical validation.

show abstract

Anti-Infectives

Thomas¹,

McCoy²

2011

High-Risk IV Medications in Special Patient Populations

View full text Add to dashboard Cite

Influence of cellulose triacetate hemodialyzers on vancomycin pharmacokinetics.

Cited by 23 publications

References 0 publications

Vancomycin and daptomycin dosing recommendations in patients receiving home hemodialysis using Monte Carlo simulation

Vancomycin and daptomycin dosing recommendations in patients receiving home hemodialysis using Monte Carlo simulation

Vancomycin and Daptomycin Dosing Recommendations in Patients Receiving Home Hemodialysis Using Monte Carlo Simulation

Anti-Infectives

Contact Info

Product

Resources

About