Is preloading with amikacin a measure able to mitigate sequestration? A preliminary in vitro study

Area of Science:

• Pharmacology
• Nephrology
• Biomaterials

Background:

• Amikacin is known to be sequestered by polyacrylonitrile (PAN) filters.
• Methods to mitigate this sequestration are not well-established.
• This study investigated amikacin elimination in a PAN-derived filter preloaded with amikacin.

Purpose of the Study:

• To evaluate the effect of preloading PAN filters with amikacin on its elimination during continuous diafiltration.
• To determine if preloading can prevent amikacin sequestration in the filter.

Main Methods:

• Amikacin concentrations were measured using an immunochemical method.
• Continuous diafiltration was performed using Prismaflex™, Baxter-Gambro, and ST™150 filters.
• A 150 mg amikacin dose was administered during priming in preload sessions.
• Pharmacokinetic calculations were performed using the NeckEpur® method.

Main Results:

• Preloading significantly increased amikacin's AUCoutlet, indicating higher drug levels in the filtrate.
• Central compartment clearance of amikacin decreased in preloaded sessions (3.75 L/h vs. 4.94 L/h).
• In preloaded sessions, amikacin elimination was solely by diafiltration (125%), with no sequestration (0%).

Conclusions:

• Preloading PAN filters with amikacin effectively prevents its sequestration.
• This modification alters amikacin disposition, potentially enhancing its removal during dialysis.
• Further research is required to establish optimal preloading dosage regimens for clinical application.