Vancomycin hemodialysis: Clearance differences between high‐flux hemodialysis and on‐line hemodiafiltration

Abstract

The aim of this study was to analyze the differences between vancomycin clearance (Kd) with high‐flux hemodialysis (HFHD) and on‐line hemodiafiltration (OL‐HDF). The OL‐HDF therapy combined the diffusion and convective transport of solutes. To compare the Kd, a vancomycin loading dose of 1 g was administered intravenously post‐dialysis to 11 chronic and anuric (<100 mL/24 h) hemodialysis patients, undergoing HFHD and post‐dilutional OL‐HDF in consecutive therapies. Additional doses of 0.5 g were administered after 45 minutes at the end of each dialysis therapy during antibiotic treatment. Blood samples were drawn from arterial and venous lines at the start of hemodialysis sessions and at the first, second, third, and fourth hours. Additional samples were drawn at 15, 30, and 45 minutes after the end of dialysis therapy. Vancomycin plasma concentration, blood urea nitrogen (BUN), creatinine, and β2‐microglobulin were measured. The patients’ hydration status was evaluated by bioimpedance analysis. The mean of vancomycin dialyzer clearance (Kddc) calculated was 110.8 ± 15 mL/min with HFHD and 146.8 ± 13.8 mL/min with OL‐HDF (P = 0.025). Significant differences were also obtained for β2‐microglobulin clearance, Kddc 72.6 ± 15.4 mL/min with HFHD and 113.4 ± 24.2 mL/min with OL‐HDF (P = 0.012), whereas no differences were found for BUN or creatinine. Additionally, to analyze differences between HFHD and OL‐HDF, a variable volume dual pool mathematical model was developed to estimate the body clearance (Kdbc), extraction mass (Me), and inter‐compartment mass‐transfer coefficient (K12) of each molecule. A higher vancomycin Kddc with OL‐HDF produced by convection improved removal of antibiotic; this can compromise achieving a therapeutic concentration target. We recommended evaluating increased loading doses of vancomycin and avoiding administration during OL‐HDF to assure adequate treatment.

Monitoreo de niveles plasmáticos de vancomicina en pacientes en hemodiálisis

“…La unión a proteínas se estima en un 20-30% en pacientes con ERC, pudiendo alcanzar un 50-55% en pacientes sin patología renal 3,5 . Presenta un prolongado efecto postantibiótico con tres fases farmacocinéticas: la primera con una rápida distribución (4-7 minutos), la segunda de distribución intermedia (30-60 minutos), y finalmente la tercera con vida media de 6-12 h en pacientes con función renal normal, que puede durar 100-200 h en pacientes anúricos 1,3 .…”

“…El uso actual de capilares de diálisis sintéticos, alto flujo y alta permeabilidad, aumenta la depuración de fármacos, entre ellos los antibióticos 1,3,6 .…”

“…Las infecciones son la segunda causa de hospitalización y morbimortalidad luego de las patologías cardiovasculares en pacientes con enfermedad renal crónica (ERC) que se encuentran en terapia de reemplazo renal (TRR) 1 . En hemodiálisis (HD), las infecciones del acceso vascular son las de mayor prevalencia.…”

Artificial Organs 2019: A year in review

“…Néstor Rodríguez et al of the Hospital Clinic Barcelona, Barcelona, Spain analyzed the differences between vancomycin clearance (Kd) with high‐flux hemodialysis (HFHD) and on‐line hemodiafiltration (OL‐HDF) in 11 chronic anuric patients. Vancomycin plasma concentration, blood urea nitrogen (BUN), creatinine, and β2‐microglobulin were measured.…”

Effective glutamate clearance from the systemic circulation by hemodialysis: Potential relevance for cerebral ischemia management

“…15 Currently, different dialysis techniques and membranes are available. Large molecules can have different clearance with different techniques and membranes, 19 but considering the nature of the glutamate molecule, it could be hypothesized that changes in glutamate levels are comparable among them. Though different rates of glutamate decrease could not be observed with different membranes or techniques, hemodynamic stability may differ among the different procedures.…”