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Renal Failure: Dose Adjustments

Renal Failure: Dose Adjustments

In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...

Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant

Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant

In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...

Hemodialysis III: Nursing Management

Hemodialysis III: Nursing Management

The nursing management of a patient undergoing hemodialysis includes several critical steps, starting with a thorough assessment before the procedure.Before the Hemodialysis ProcedureFirst, record the patient's vital signs—blood pressure, heart rate, respiratory rate, and temperature—to establish a baseline. This baseline is essential for detecting conditions such as hypotension that could impact the patient's response to dialysis. Document the patient's pre-dialysis weight, as this measurement...

Hemodialysis II: Procedure and Complications

Hemodialysis II: Procedure and Complications

DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...

Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance

Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance

In healthy individuals, serum creatinine levels remain stable due to a balance between its constant production—primarily from muscle metabolism—and renal excretion. Creatinine is freely filtered by the glomeruli, making it a valuable marker for estimating renal function. When the glomerular filtration rate (GFR) decreases, the kidneys can only eliminate less creatinine, causing serum levels to rise.Serum creatinine concentration is widely used to estimate creatinine clearance (Clcr), a...

Estimation of k and VD of Aminoglycosides

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Updated: Jun 27, 2026

A Novel Method to Determine the Longitudinal Antibacterial Activity of Drug-Eluting Materials

A Novel Method to Determine the Longitudinal Antibacterial Activity of Drug-Eluting Materials

Published on: March 3, 2023

[Vancomycin dosing in hemodialysis patients].

I Castellano¹, P M González Castillo, A Covarsí

¹Servicio de Nefrología, Hospital San Pedro de Alcántara, Cáceres, España. ines.castellano@ses.juntaex.es

Nefrologia : Publicacion Oficial De La Sociedad Espanola Nefrologia

|November 20, 2008

Summary

A 1g intravenous vancomycin dose every 5-7 days is insufficient for haemodialysis patients with high flux membranes. Monitoring predialysis vancomycin levels is crucial to prevent subtherapeutic antibiotic concentrations.

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Last Updated: Jun 27, 2026

A Novel Method to Determine the Longitudinal Antibacterial Activity of Drug-Eluting Materials

A Novel Method to Determine the Longitudinal Antibacterial Activity of Drug-Eluting Materials

Published on: March 3, 2023

Area of Science:

Pharmacology
Nephrology
Infectious Diseases

Context:

Vancomycin is a critical antibiotic for treating St. Aureus infections in haemodialysis patients.
Optimizing vancomycin dosing is essential to prevent subtherapeutic levels in patients undergoing haemodialysis, particularly those using high flux membranes.

Purpose:

To evaluate the efficacy of a 1g intravenous vancomycin dose in achieving optimal plasma levels in chronic haemodialysis patients.
To assess the impact of different factors, including membrane type and dosage relative to body weight, on vancomycin levels.

Summary:

A study involving 28 chronic haemodialysis patients found that a 1g intravenous vancomycin dose every 5-7 days frequently resulted in subtherapeutic plasma levels, especially when using high flux membranes.
Lower doses (<15 mg/kg) and specific high flux membranes (PES-AP) were associated with a higher incidence of suboptimum vancomycin concentrations.
All post-dialysis and pre-second-dialysis vancomycin levels were found to be subtherapeutic.

Impact:

The findings challenge the current vancomycin dosing regimen for haemodialysis patients with high flux membranes.
Suggests the need for individualized vancomycin dosing strategies and routine monitoring of predialysis plasma levels to ensure therapeutic efficacy.
Highlights the importance of considering membrane type in antibiotic dosing protocols for haemodialysis patients.