Vancomycin pharmacokinetics and pharmacodynamics during short daily hemodialysis

Brian Decker, Michael B. Kays, Mary Chambers, Michael Kraus, Sharon Moe, Kevin M. Sowinski

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background and objectives: Short daily hemodialysis (SDHD) is an alternative to thrice-weekly HD because of its putative physiologic benefits. The purpose of this study was to investigate the effect of SDHD on the pharmacokinetics and pharmacodynamics of vancomycin. Design, setting, participants, & measurements: Six noninfected adults who had anuria and were treated with SDHD were studied and received four dialysis sessions over 4 days. After completion of the first SDHD, each patient received vancomycin 15 mg/kg by intravenous infusion. Blood samples were collected over the ensuing 3 days during each subsequent inter- and intradialytic period. Pharmacokinetic parameters were determined. Serum concentration-time profiles were simulated for four vancomycin regimens with maintenance doses administered after every other SDHD. Area under the serum-concentration time curve (AUC) from 0 to 48 hours, 48 to 96 hours, and 96 to 144 hours were calculated, and Monte Carlo simulations were performed to determine the probability of target attainment at an AUC/minimum inhibitory concentration (MIC) ratio ≥800 for each 48-hour AUC at MICs ranging from 0.5 to 2.0 μg/ml. Results: Median (range) systemic clearance was 7.2 ml/min (5.3 to 10.0 ml/min), and dialytic clearance was 104 ml/min (94 to 106 ml/min). The steady-state volume of distribution was 55.4 L (34.8 to 77.2 L). At MICs ≤1 μg/ml, probability of target attainment was >90% for each 48-hour AUC when vancomycin was administered as a 20-mg/kg loading dose followed by 10 mg/kg after every other SDHD. Conclusions: Vancomycin pharmacokinetic parameters in SDHD are consistent with data from thrice-weekly HD. A loading dose of 20 mg/kg followed by 10 mg/kg after every other SDHD provides adequate exposure for pathogens with MICs ≤1 μg/ml.

Original languageEnglish
Pages (from-to)1981-1987
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Volume5
Issue number11
DOIs
StatePublished - Nov 1 2010

Fingerprint

Vancomycin
Renal Dialysis
Pharmacokinetics
Area Under Curve
Anuria
Microbial Sensitivity Tests
Serum
Intravenous Infusions
Dialysis

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Vancomycin pharmacokinetics and pharmacodynamics during short daily hemodialysis. / Decker, Brian; Kays, Michael B.; Chambers, Mary; Kraus, Michael; Moe, Sharon; Sowinski, Kevin M.

In: Clinical Journal of the American Society of Nephrology, Vol. 5, No. 11, 01.11.2010, p. 1981-1987.

Research output: Contribution to journalArticle

Decker, Brian ; Kays, Michael B. ; Chambers, Mary ; Kraus, Michael ; Moe, Sharon ; Sowinski, Kevin M. / Vancomycin pharmacokinetics and pharmacodynamics during short daily hemodialysis. In: Clinical Journal of the American Society of Nephrology. 2010 ; Vol. 5, No. 11. pp. 1981-1987.
@article{04dcbf2d3a9845519411d9960a586dc0,
title = "Vancomycin pharmacokinetics and pharmacodynamics during short daily hemodialysis",
abstract = "Background and objectives: Short daily hemodialysis (SDHD) is an alternative to thrice-weekly HD because of its putative physiologic benefits. The purpose of this study was to investigate the effect of SDHD on the pharmacokinetics and pharmacodynamics of vancomycin. Design, setting, participants, & measurements: Six noninfected adults who had anuria and were treated with SDHD were studied and received four dialysis sessions over 4 days. After completion of the first SDHD, each patient received vancomycin 15 mg/kg by intravenous infusion. Blood samples were collected over the ensuing 3 days during each subsequent inter- and intradialytic period. Pharmacokinetic parameters were determined. Serum concentration-time profiles were simulated for four vancomycin regimens with maintenance doses administered after every other SDHD. Area under the serum-concentration time curve (AUC) from 0 to 48 hours, 48 to 96 hours, and 96 to 144 hours were calculated, and Monte Carlo simulations were performed to determine the probability of target attainment at an AUC/minimum inhibitory concentration (MIC) ratio ≥800 for each 48-hour AUC at MICs ranging from 0.5 to 2.0 μg/ml. Results: Median (range) systemic clearance was 7.2 ml/min (5.3 to 10.0 ml/min), and dialytic clearance was 104 ml/min (94 to 106 ml/min). The steady-state volume of distribution was 55.4 L (34.8 to 77.2 L). At MICs ≤1 μg/ml, probability of target attainment was >90{\%} for each 48-hour AUC when vancomycin was administered as a 20-mg/kg loading dose followed by 10 mg/kg after every other SDHD. Conclusions: Vancomycin pharmacokinetic parameters in SDHD are consistent with data from thrice-weekly HD. A loading dose of 20 mg/kg followed by 10 mg/kg after every other SDHD provides adequate exposure for pathogens with MICs ≤1 μg/ml.",
author = "Brian Decker and Kays, {Michael B.} and Mary Chambers and Michael Kraus and Sharon Moe and Sowinski, {Kevin M.}",
year = "2010",
month = "11",
day = "1",
doi = "10.2215/CJN.03450410",
language = "English",
volume = "5",
pages = "1981--1987",
journal = "Clinical journal of the American Society of Nephrology : CJASN",
issn = "1555-9041",
publisher = "American Society of Nephrology",
number = "11",

}

TY - JOUR

T1 - Vancomycin pharmacokinetics and pharmacodynamics during short daily hemodialysis

AU - Decker, Brian

AU - Kays, Michael B.

AU - Chambers, Mary

AU - Kraus, Michael

AU - Moe, Sharon

AU - Sowinski, Kevin M.

PY - 2010/11/1

Y1 - 2010/11/1

N2 - Background and objectives: Short daily hemodialysis (SDHD) is an alternative to thrice-weekly HD because of its putative physiologic benefits. The purpose of this study was to investigate the effect of SDHD on the pharmacokinetics and pharmacodynamics of vancomycin. Design, setting, participants, & measurements: Six noninfected adults who had anuria and were treated with SDHD were studied and received four dialysis sessions over 4 days. After completion of the first SDHD, each patient received vancomycin 15 mg/kg by intravenous infusion. Blood samples were collected over the ensuing 3 days during each subsequent inter- and intradialytic period. Pharmacokinetic parameters were determined. Serum concentration-time profiles were simulated for four vancomycin regimens with maintenance doses administered after every other SDHD. Area under the serum-concentration time curve (AUC) from 0 to 48 hours, 48 to 96 hours, and 96 to 144 hours were calculated, and Monte Carlo simulations were performed to determine the probability of target attainment at an AUC/minimum inhibitory concentration (MIC) ratio ≥800 for each 48-hour AUC at MICs ranging from 0.5 to 2.0 μg/ml. Results: Median (range) systemic clearance was 7.2 ml/min (5.3 to 10.0 ml/min), and dialytic clearance was 104 ml/min (94 to 106 ml/min). The steady-state volume of distribution was 55.4 L (34.8 to 77.2 L). At MICs ≤1 μg/ml, probability of target attainment was >90% for each 48-hour AUC when vancomycin was administered as a 20-mg/kg loading dose followed by 10 mg/kg after every other SDHD. Conclusions: Vancomycin pharmacokinetic parameters in SDHD are consistent with data from thrice-weekly HD. A loading dose of 20 mg/kg followed by 10 mg/kg after every other SDHD provides adequate exposure for pathogens with MICs ≤1 μg/ml.

AB - Background and objectives: Short daily hemodialysis (SDHD) is an alternative to thrice-weekly HD because of its putative physiologic benefits. The purpose of this study was to investigate the effect of SDHD on the pharmacokinetics and pharmacodynamics of vancomycin. Design, setting, participants, & measurements: Six noninfected adults who had anuria and were treated with SDHD were studied and received four dialysis sessions over 4 days. After completion of the first SDHD, each patient received vancomycin 15 mg/kg by intravenous infusion. Blood samples were collected over the ensuing 3 days during each subsequent inter- and intradialytic period. Pharmacokinetic parameters were determined. Serum concentration-time profiles were simulated for four vancomycin regimens with maintenance doses administered after every other SDHD. Area under the serum-concentration time curve (AUC) from 0 to 48 hours, 48 to 96 hours, and 96 to 144 hours were calculated, and Monte Carlo simulations were performed to determine the probability of target attainment at an AUC/minimum inhibitory concentration (MIC) ratio ≥800 for each 48-hour AUC at MICs ranging from 0.5 to 2.0 μg/ml. Results: Median (range) systemic clearance was 7.2 ml/min (5.3 to 10.0 ml/min), and dialytic clearance was 104 ml/min (94 to 106 ml/min). The steady-state volume of distribution was 55.4 L (34.8 to 77.2 L). At MICs ≤1 μg/ml, probability of target attainment was >90% for each 48-hour AUC when vancomycin was administered as a 20-mg/kg loading dose followed by 10 mg/kg after every other SDHD. Conclusions: Vancomycin pharmacokinetic parameters in SDHD are consistent with data from thrice-weekly HD. A loading dose of 20 mg/kg followed by 10 mg/kg after every other SDHD provides adequate exposure for pathogens with MICs ≤1 μg/ml.

UR - http://www.scopus.com/inward/record.url?scp=78149306096&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78149306096&partnerID=8YFLogxK

U2 - 10.2215/CJN.03450410

DO - 10.2215/CJN.03450410

M3 - Article

C2 - 20616157

AN - SCOPUS:78149306096

VL - 5

SP - 1981

EP - 1987

JO - Clinical journal of the American Society of Nephrology : CJASN

JF - Clinical journal of the American Society of Nephrology : CJASN

SN - 1555-9041

IS - 11

ER -