Daptomycin clearance during modeled continuous renal replacement therapy.
OBJECTIVE
Pharmacotherapy in critically ill patients receiving continuous renal replacement therapies (CRRT) is challenging due to the lack of published information to base dosing regimens.


METHODS
Daptomycin's transmembrane clearance during continuous hemofiltration and hemodialysis was assessed using an in vitro model with AN69 and polysulfone hemodiafilters at varying ultrafiltrate and dialysate flow rates (1, 2, 3 and 6 l/h).


RESULTS
During continuous hemofiltration, mean daptomycin sieving coefficient ranged from 0.14 to 0.20. Transmembrane clearances were significantly different between filter types for ultrafiltration rates of 2, 3 and 6 l/h. For continuous hemodialysis, mean daptomycin saturation coefficient ranged from 0.05 to 0.15. AN69-based daptomycin clearances were significantly lower than polysulfone values at dialysate flow rates of 2, 3 and 6 l/h.


CONCLUSIONS
The extent of daptomycin's transmembrane clearance is dependent on hemodiafilter type, dialysate and ultrafiltration rates. CRRT with high ultrafiltrate or dialysate rates may result in substantial daptomycin clearances.
Churchwell
Mariann D
MD
The University of Toledo, College of Pharmacy, Department of Pharmacy Practice, Toledo, Ohio, USA. Mariann.Churchwell@utoledo.edu
Pasko
Deborah A
DA
Mueller
Bruce A
BA
D058186:Acute Kidney Injury / Q000628:therapy; D000818:Animals; D000900:Anti-Bacterial Agents / Q000737:chemistry*; D002417:Cattle; D017576:Daptomycin / Q000737:chemistry*; D006440:Hemofiltration / Q000295:instrumentation; D006801:Humans; D008567:Membranes, Artificial; D008954:Models, Biological
D000900:Anti-Bacterial Agents; D008567:Membranes, Artificial; D017576:Daptomycin