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Effects of dialysis membrane on intradialytic vancomycin administration
M K Scott1, W L Macias, M A Kraus
1Department of Pharmacy Practice, School of Pharmacy and Pharmacal Sciences, Purdue University, West Lafayette, Indiana, USA.
Study Objective:
To quantify the influence of hemodialyzers on vancomycin removal when the drug was infused during hemodialysis.
Design:
Prospective, controlled, crossover study with three arms.
Setting:
A university-affiliated medical center.
Patients:
Eight subjects receiving outpatient hemodialysis.
Interventions:
The three treatment arms were vancomycin 1000 mg infused after dialysis was completed (control), and the same dosages infused during the last hour of hemodialysis with a cellulose triacetate (CT) and a cellulose acetate (CA) hemodialyzer.
Measurements And Main Results:
The areas under the curve from time zero to 44 hours (AUC0-44 hrs) for the three study arms were significantly different (p < 0.05), with the mean vancomycin AUC0-44 hrs being significantly lower when administered during CT and CA dialysis (73.7% and 87.2% of control; p < 0.05 vs control). The mean vancomycin peak concentration achieved during CT dialysis was significantly lower than for the CA and control arms (20.5, 23.9, 27.0 mg/L, respectively). Forty-four-hour postinfusion concentrations were similarly lower.
Conclusion:
Clinicians should recognize that the composition of the hemodialyzer significantly influences vancomycin serum concentrations when the drug is administered during hemodialysis.