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Related Experiment Videos

Falsely elevated serum vancomycin concentrations in hemodialysis patients

S L Follin1, B A Mueller, M K Scott

  • 1Department of Pharmacy, St Joseph Hospital, Denver, CO 80218-1191, USA.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|January 1, 1996
PubMed
Summary

Fluorescence polarization immunoassay (FPIA) overestimates vancomycin levels in end-stage renal disease (ESRD) patients on hemodialysis compared to enzyme multiplied immunoassay technique (EMIT). This inaccuracy can lead to vancomycin underdosing and potential treatment failure.

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Area of Science:

  • Clinical Chemistry
  • Pharmacokinetics
  • Nephrology

Background:

  • Fluorescence polarization immunoassay (FPIA) is a common clinical assay for vancomycin.
  • Concerns exist regarding FPIA's accuracy in end-stage renal disease (ESRD) patients.
  • No prior studies evaluated FPIA accuracy in ESRD patients undergoing maintenance hemodialysis.

Purpose of the Study:

  • To compare the vancomycin assay performance of FPIA and enzyme multiplied immunoassay technique (EMIT) in ESRD patients on hemodialysis.
  • To assess the impact of assay differences on vancomycin dosing recommendations.

Main Methods:

  • Six ESRD patients received 1g vancomycin weekly during hemodialysis for six weeks.
  • Vancomycin serum concentrations were measured using both FPIA and EMIT assays.

Related Experiment Videos

  • Vancomycin dosing regimens were calculated based on both assay results to achieve target concentrations.

    • Main Results:

    • FPIA consistently reported significantly higher vancomycin serum concentrations than EMIT.
    • Mean differences in peak concentrations ranged from 7.5 to 11.2 mg/L; trough concentrations ranged from 4.2 to 6.2 mg/L.
    • FPIA-derived dosing recommendations were lower than EMIT-derived doses, potentially leading to underdosing.

    Conclusions:

    • FPIA significantly overestimates vancomycin serum concentrations in ESRD patients on high-efficiency hemodialysis compared to EMIT.
    • This overestimation can lead to suboptimal vancomycin dosing and therapeutic failure.
    • The EMIT vancomycin assay is recommended for ESRD patients to ensure accurate dosing.