title: Detectability of vasopressin in continuous venovenous hemodialysis effluent of patients with vasodilatory shock treated with exogenous arginine vasopressin.
abstract: To determine whether vasopressin is detectable in the continuous venovenous hemodialysis (CVVHD) effluent of patients receiving exogenous arginine vasopressin, and to determine whether treatment-specific factors are associated with vasopressin levels in CVVHD effluent. DESIGN. Prospective observational study. SETTING. Intensive care units of a tertiary care academic medical center. PATIENTS. Twenty-seven adults with vasodilatory shock who received a stable-dose continuous intravenous infusion of arginine vasopressin with concomitant uninterrupted CVVHD for at least 4 hours between September 2008 and May 2010. MEASUREMENTS AND MAIN RESULTS. Vasopressin levels in CVVHD effluent were assessed by radioimmunoassay. Statistical analysis was performed with analysis of variance and Pearson correlation. A multivariate linear regression was used to assess for independent factors associated with vasopressin levels in CVVHD effluent. The CVVHD effluent of all patients was assessed for vasopressin levels. The median exogenous arginine vasopressin dose was 0.03 unit/minute (range 0.02-0.18 unit/min), whereas the median CVVHD effluent flow rate was 22.6 ml/kg/hour (interquartile range [IQR] 21.5-26.8 ml/kg/hr). Vasopressin was detectable in all effluent samples (median 88.8 pg/ml, IQR 36.4-113.7 pg/ml). There were no significant differences in CVVHD effluent vasopressin levels among CVVHD filter types (p=0.39). The CVVHD effluent vasopressin levels correlated with exogenous arginine vasopressin dose (r2=0.49, p<0.001). After adjustment for CVVHD effluent flow rate and administration of corticosteroids, with multivariate linear regression, only exogenous arginine vasopressin dose was independently associated with CVVHD effluent vasopressin level. CONCLUSION. Vasopressin is detectable in CVVHD effluent, suggesting that it is removed by CVVHD. In addition, exogenous arginine vasopressin infusion dose is independently associated with CVVHD effluent vasopressin level.
authors.affiliation: Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio. bauers@ccf.org
authors.forename: Seth R
authors.initials: SR
authors.lastname: Bauer
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Culver
authors.forename: Susamma
authors.initials: S
authors.lastname: Abraham
authors.forename: Simon W
authors.initials: SW
authors.lastname: Lam
authors.forename: William H
authors.initials: WH
authors.lastname: Fissell
authors.forename: Herbert P
authors.initials: HP
authors.lastname: Wiedemann
authors.forename: Anita J
authors.initials: AJ
authors.lastname: Reddy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001127:Arginine Vasopressin / Q000493:pharmacokinetics* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D015312:Hemodialysis Solutions / Q000737:chemistry*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D012769:Shock / Q000188:drug therapy* / Q000628:therapy; D014664:Vasodilation; D014667:Vasopressins / Q000032:analysis*
chemical_list: D015312:Hemodialysis Solutions; D014667:Vasopressins; D001127:Arginine Vasopressin