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Vancomycin removal and pharmacokinetics during accelerated venovenous hemofiltration
Natasha D Lopez1, Michael Griggs2, Jonathan H Sin1
1Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA.
Pharmacotherapy
|October 5, 2023
Summary
Accelerated venovenous hemofiltration (AVVH) significantly removes vancomycin, necessitating higher doses after treatment to maintain therapeutic levels. Regular therapeutic drug monitoring is crucial for patients on AVVH.
Area of Science:
- Pharmacology
- Nephrology
- Critical Care Medicine
Background:
- Vancomycin pharmacokinetics are altered in critically ill patients undergoing renal replacement therapy.
- Limited data exist on vancomycin removal during accelerated venovenous hemofiltration (AVVH).
- Understanding vancomycin behavior during AVVH is essential for optimizing patient treatment.
Purpose of the Study:
- To characterize vancomycin pharmacokinetics and removal during AVVH.
- To determine the impact of AVVH on vancomycin serum concentrations.
- To provide dosing recommendations for vancomycin in patients receiving AVVH.
Main Methods:
- Eighteen critically ill adults receiving vancomycin and AVVH were studied.
- Vancomycin serum concentrations were measured before and after AVVH sessions.
- Pharmacokinetic parameters were calculated using one-compartmental analysis.
Main Results:
- AVVH reduced vancomycin concentrations by approximately 30% during treatment.
- The median vancomycin elimination rate was 3.4% per hour of AVVH.
- Higher vancomycin doses (median 1000 mg) were required post-AVVH to achieve target trough concentrations (≥15 mg/L).
Conclusions:
- Vancomycin is substantially cleared by AVVH.
- Supplemental vancomycin dosing is necessary after AVVH to maintain therapeutic efficacy.
- Therapeutic drug monitoring of vancomycin is recommended for patients undergoing AVVH.
Keywords:
accelerated venovenous hemofiltration (AVVH)critical carepharmacokineticsprolonged intermittent renal replacement therapy (PIRRT)renal failurevancomycinMore Related Videos
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