Vancomycin Dosing in Patients on Intermittent Hemodialysis-A Retrospective Study
Jacqueline Martin1, Colin M Curtain2, Mohammed S Salahudeen2
1School of Pharmacy and Pharmacology, University of Tasmania, Sandy Bay, Australia; Pharmacy Department, Alice Springs Hospital, Alice Springs, Australia.
Clinical Therapeutics
|January 28, 2025
Summary
Vancomycin dosing in hemodialysis (HD) patients frequently misses therapeutic targets. Adjusting loading doses and optimizing maintenance intervals are crucial for effective vancomycin therapy in chronic kidney disease stage 5 patients.
Area of Science:
- Pharmacokinetics and Pharmacodynamics
- Nephrology
- Infectious Diseases
Background:
- Vancomycin is essential for treating infections in hemodialysis (HD) patients.
- Achieving therapeutic vancomycin concentrations is critical for efficacy and safety.
- Current three-times-weekly dosing protocols may lead to suboptimal attainment.
Purpose of the Study:
- To evaluate the incidence of therapeutic target attainment for vancomycin therapy.
- To assess vancomycin dosing during intermittent hemodialysis (HD) using a three-times-weekly protocol.
Main Methods:
- Retrospective cohort study of 98 vancomycin courses in adult patients with chronic kidney disease stage 5 on HD.
- Analysis of serum vancomycin concentrations against therapeutic targets (15-20 mg/L).
- Assessment of clinician adherence to dosing protocols and factors influencing target attainment.
Main Results:
- Only 38% of loading doses followed protocol; 50% of initial trough concentrations were sub-therapeutic.
- Sub-therapeutic levels linked to lower loading doses; supra-therapeutic levels to shorter pre-maintenance intervals.
- 65% of maintenance trough concentrations were therapeutic, but 48-h and 72-h intervals showed varied attainment.
Conclusions:
- High rates of target nonattainment observed with the three-times-weekly vancomycin regimen in HD patients.
- Recommendations include a 20-25 mg/kg loading dose and refined post-loading intervals.
- Further pharmacokinetic studies are needed to optimize vancomycin dosing in this population.
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