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Hemodialysis of amikacin in critically ill patients
D K Armstrong1, T Hodgman, J A Visconti
1Department of Pharmacy, Ohio State University Hospitals, Columbus.
Abstract:
The clearance of amikacin during hemodialysis (HD) was determined in eight critically ill patients. The dialysis period averaged 3.4 h with a blood flow of 200 ml/min. The average amikacin clearance between dialysis was 7.30 +/- 4.78 (SD) ml/min which increased to 37.5 +/- 8.01 ml/min during dialysis. The average serum amikacin concentration before dialysis fell 27% after dialysis. The fraction of drug in the body removed only from dialysis averaged 21%. Although amikacin was cleared more effectively during HD compared to the interdialysis period, the small amount of drug removed suggests that routine supplemental dosing of amikacin after HD may not be necessary.
Insights
Amikacin clearance significantly increases during hemodialysis (HD), but the total amount removed is small. Routine supplemental dosing after HD may not be necessary for critically ill patients.
Area of Science:
- Pharmacokinetics
- Nephrology
- Critical Care Medicine
Background:
- Amikacin is an aminoglycoside antibiotic commonly used in critically ill patients.
- Aminoglycoside dosing requires careful consideration in patients with impaired renal function or undergoing renal replacement therapy.
- Hemodialysis (HD) can significantly alter drug clearance, necessitating an understanding of its impact on amikacin levels.
Purpose of the Study:
- To quantify amikacin clearance during hemodialysis in critically ill patients.
- To determine the impact of hemodialysis on serum amikacin concentrations.
- To evaluate the necessity of supplemental amikacin dosing after hemodialysis.
Main Methods:
- Eight critically ill patients receiving amikacin were studied.
- Amikacin serum concentrations were measured before and after hemodialysis.
- Amikacin clearance was calculated during the interdialysis period and during hemodialysis (average 3.4 h, 200 ml/min blood flow).
Main Results:
- Amikacin clearance increased from 7.30 ml/min between dialysis sessions to 37.5 ml/min during dialysis.
- Serum amikacin concentrations decreased by an average of 27% after a dialysis session.
- The fraction of amikacin removed solely by dialysis averaged 21%.
Conclusions:
- Amikacin is cleared more effectively during hemodialysis compared to the interdialysis period.
- The overall amount of amikacin removed by hemodialysis is relatively small.
- Routine supplemental amikacin dosing after hemodialysis may not be required in critically ill patients.