Vancomycin Removal During High-Volume Peritoneal Dialysis in Acute Kidney Injury Patients: A Prospective Cohort Clinical Study

Abstract

IntroductionVancomycin pharmacokinetic data in patients with acute kidney injury (AKI) on high-volume peritoneal dialysis (HVPD) are lacking. The aims were to study the pharmacokinetics of i.v. vancomycin in patients with AKI treated by HVPD who received an i.v. dose of vancomycin (15–20 mg/kg), to determine the vancomycin removal, and to establish vancomycin dosing and evaluation pharmacokinetics target attainment achievement for the empirical treatment of patients with AKI treated by HVPD.MethodsVancomycin was administered 1 hour before dialysis start. Samples of all dialysate were collected for a 24-hour period. Blood samples were collected after 1, 2, 4, and 24 hours of therapy. Vancomycin concentrations were determined using a liquid chromatographic (high-performance liquid chromatography)–fluorescence method. Pharmacokinetic calculations were completed assuming a 1-compartment model.ResultsTen patients completed the study. The mean vancomycin dose administered was 18.0 ± 2.95 mg/kg (14.7–21.8 mg/kg) on the day of study (first day) and the mean percentage of vancomycin removal by HVPD was 21.7% ± 2.2% (16%–29%). Peritoneal clearance was 8.1 ± 2.2 ml/min (5.3–12 ml/min). The serum vancomycin half-life was 71.2 ± 24.7 hours (42–110 hours) during HVPD session, the maximum serum concentration was 26.2 ± 3.5 mg/l, which occurred 1 hour after vancomycin administration and HVPD start. Area under the curve (AUC)0–24/minimum inhibitory concentration (MIC) ratio ≥400 was achieved in all patients when MIC = 1 mg/l was considered.ConclusionHVPD removes considerable amounts of vancomycin in septic patients with AKI. Administration of 18 mg/kg vancomycin each 48 to 72 hours in patients with AKI undergoing HVPD was required to reach and maintain therapeutic concentrations.

A retrospective analysis to estimate trough concentrations of teicoplanin in patients with suspected or documented Gram-positive infections

“…Some researchers have suggested that teicoplanin could be used as an alternative to vancomycin to treat infections caused by MRSA or other resistant gram-positive organisms (Wood, 1996;Wood, 2000;Svetitsky, Leibovici, Paul, 2009;Yoon et al, 2014). Both teicoplanin and vancomycin are mainly excreted through the kidney and hence their elimination half-life is prolonged in patients with renal failure (Li et al, 2017;Ponce et al, 2018). Considering that the maintenance dose of teicoplanin is onceper day and that it has a lower rate of dose-related nephrotoxicity, teicoplanin is likely to be superior to vancomycin for clinical antibacterial application (Svetitsky, Leibovici, Paul, 2009;Shime et al, 2018).…”

Vancomycin for Dialytic Therapy in Critically Ill Patients: Analysis of Its Reduction and the Factors Associated with Subtherapeutic Concentrations

“…Our results were higher than those found by Golestaneh et al [36], which presented a reduction of 36% in 10 patients receiving PHD with a duration of at least 8 h. When they analysed the removal of vancomycin from dialysate in patients with sepsis and AKI treated with PHD using high-flux membranes, Kielstein et al [37] observed 26% removal of vancomycin from the dialysate. In a study by our group, the removal of vancomycin through high-volume peritoneal dialysis was 21.7% [38].…”

Greetings to the readers

“…We should remember that in most settings, renal replacement therapy in the Intensive Care Units is still associated with at least 50% in mortality rate [10,[16][17][18] obviously, the current status quo of practice (and knowledge) is insufficient and the one thing that cannot be justified is inertia. To mention just a few examples, there is exciting literature emerging on fluid overload and volume determination in critically ill patients with acute kidney injury (AKI) [19][20][21][22], the impact of other organ failures (liver, heart) in AKI [23], on peritoneal dialysis as a viable alternative for continuous renal replacement therapy [24,25] and on the uniqueness of medication dosing in those with critical illness receiving renal replacement therapy [26,27]. All these issues will likely expand in the future and attract a global readership.…”