CAHP-210 dialyzer influence on intra-dialytic vancomycin removal.
BACKGROUND
Vancomycin is often administered during the last hour of haemodialysis because it was not removed significantly by older hemodialyzers. However, newer higher permeability hemodialyzers remove vancomycin, although the amount removed varies considerably between dialyzers. The purpose of this study was to determine the apparent amount of vancomycin removed during the last hour of haemodialysis with a CAHP-210 hemodialyzer.


METHODS
Eight subjects with end-stage renal disease (ESRD) received i.v. vancomycin 15 mg/kg after their regular haemodialysis session ended. Serum samples for the determination of vancomycin concentrations were obtained serially for 44 h. After a 3-week washout, the study was repeated with the vancomycin infused during the last hour of their regular haemodialysis session using a CAHP-210 hemodialyzer. Vancomycin concentrations were determined by the Enzyme Multiplied Immunoassay Technique. Differential equations describing a two-compartment open infusion model were fitted to the serum concentration vs time data and pharmacokinetic parameters and apparent vancomycin removal was estimated.


RESULTS
The median age and weight of the subjects were 52 years (range 37-71) and 75.6 kg (range 37.6-89.8), respectively. The apparent vancomycin intra-dialytic removal was 0.24 (range -0.07-0.35), which was statistically significantly different from zero.


CONCLUSIONS
Vancomycin administered during the last hour of CAHP-210 dialysis results in 24% less vancomycin exposure than when administered post-haemodialysis. This intra-dialytic drug loss should be accounted for when dosing vancomycin in this manner.
Department of Pharmacy Practice, School of Pharmacy and Pharmacal Sciences, Purdue University, Indianapolis 46202, USA.
Aroonrut
A
Lucksiri
Meri K
MK
Scott
Bruce A
BA
Mueller
Richard J
RJ
Hamburger
Kevin M
KM
Sowinski
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D018592:Cross-Over Studies; D004867:Equipment Design; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D007700:Kinetics; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D006435:Renal Dialysis / Q000295:instrumentation*; D014640:Vancomycin / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014640:Vancomycin