title: Clearance of vancomycin during high-volume haemofiltration: impact of pre-dilution.
abstract: OBJECTIVE
  To measure the sieving coefficient (SC) and clearance of vancomycin during high-volume haemofiltration (HVHF) and to evaluate the impact of different pre-dilution regimens on these variables.
  
  
  METHODS
  Prospective interventional study in the intensive care unit in a tertiary university hospital.
  
  
  METHODS
  Seven patients with septic shock and multi-organ dysfunction.
  
  
  METHODS
  HVHF (6 l/h fluid exchange) was performed in septic shock patients using variable proportions of their replacement fluid in pre- and post-dilution mode.
  
  
  RESULTS
  Pre-filter, post-filter and ultrafiltrate vancomycin concentrations were measured simultaneously, and SC and clearance calculated. The measurements were repeated following each change in the proportion of pre-dilution fluid. SC steadily decreased as the proportion of pre-dilution decreased, changing from 0.76 in pure pre-dilution to 0.57 in pure post-dilution (p=0.0004). Clearance, however, increased with decreasing pre-dilution fluid rate, from 53.9 ml/min at pure pre-dilution to 67.2 ml/min at 2 l/h pre-dilution with 4 l/h post-dilution.
  
  
  CONCLUSIONS
  HVHF achieves high vancomycin clearances, which despite some deterioration in SC increase with the proportion of replacement fluid given post-filter. Clinicians applying HVHF need to be aware of such clearances to avoid inadequate vancomycin dosing and to adjust therapy according to variations in HVHF technique.
authors.affiliation: Department of Intensive Care and Medicine, University of Melbourne, and Austin & Repatriation Medical Centre Melbourne, Heidelberg, Victoria, Australia.
authors.forename: Shigehiko
authors.initials: S
authors.lastname: Uchino
authors.forename: Louise
authors.initials: L
authors.lastname: Cole
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Morimatsu
authors.forename: Donna
authors.initials: D
authors.lastname: Goldsmith
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy; D000368:Aged; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics*; D016638:Critical Illness; D018592:Cross-Over Studies; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications / Q000628:therapy*; D011446:Prospective Studies; D012772:Shock, Septic / Q000150:complications / Q000628:therapy*; D014640:Vancomycin / Q000493:pharmacokinetics*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin