Effects of dialysis membrane on intradialytic vancomycin administration.
OBJECTIVE
To quantify the influence of hemodialyzers on vancomycin removal when the drug was infused during hemodialysis.


METHODS
Prospective, controlled, crossover study with three arms.


METHODS
A university-affiliated medical center.


METHODS
Eight subjects receiving outpatient hemodialysis.


METHODS
The three treatment arms were vancomycin 1000 mg infused after dialysis was completed (control), and the same dosages infused during the last hour of hemodialysis with a cellulose triacetate (CT) and a cellulose acetate (CA) hemodialyzer.


RESULTS
The areas under the curve from time zero to 44 hours (AUC0-44 hrs) for the three study arms were significantly different (p < 0.05), with the mean vancomycin AUC0-44 hrs being significantly lower when administered during CT and CA dialysis (73.7% and 87.2% of control; p < 0.05 vs control). The mean vancomycin peak concentration achieved during CT dialysis was significantly lower than for the CA and control arms (20.5, 23.9, 27.0 mg/L, respectively). Forty-four-hour postinfusion concentrations were similarly lower.


CONCLUSIONS
Clinicians should recognize that the composition of the hemodialyzer significantly influences vancomycin serum concentrations when the drug is administered during hemodialysis.
Scott
M K
MK
Department of Pharmacy Practice, School of Pharmacy and Pharmacal Sciences, Purdue University, West Lafayette, Indiana, USA.
Macias
W L
WL
Kraus
M A
MA
Clark
W R
WR
Carfagna
M A
MA
Mueller
B A
BA
D000900:Anti-Bacterial Agents / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use; D002482:Cellulose / Q000031:analogs & derivatives; D018592:Cross-Over Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008567:Membranes, Artificial; D010539:Permeability; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D014640:Vancomycin / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D008567:Membranes, Artificial; C005062:acetylcellulose; D014640:Vancomycin; D002482:Cellulose; C024671:cellulose triacetate