085 VANCOMYCIN REMOVAL IN PATIENTS ON HIGH-FLUX INTERMITTENT HEMODIALYSIS - VARELI

Abstract

Category: Other Presenter: Mr ZAI YANG YONG Keywords: hemodialysis, vancomycin, high-flux High-flux dialysis membrane is commonly used nowadays and studies have shown that vancomycin is significant removed with high-flux hemodialysis (HD). Furthermore, there is a rebound of vancomycin level 3-6 hours after HD due to redistribution. In our hospital, vancomycin dosing is currently based on pre HD serum concentration of less than 20 μg/mL but this may result in under-dosing due to drug removal during high-flux HD. To determine the extent of vancomycin removal with high-flux intermittent HD. This is a prospective, observational study performed at Sarawak General Hospital, Kuching from June 2016 to May 2017. All patients on high-flux HD who received vancomycin with a trough level of more than 20 μg/mL pre HD were recruited into this study. Vancomycin levels were measured pre HD, at completion of 4 hours of HD and 6 hours after HD. The serum concentrations of vancomycin were determined by Enzyme Multiplied Immunoassay Technique (EMIT) using SIEMENS VIVA E. Data were analysed using descriptive statistics. A total of 8 patients were recruited into this study. The mean (SD) vancomycin serum concentrations pre HD, upon completion of 4-hour HD, and 6 hours post HD were 28.89 (5.03) μg/mL, 16.18 (4.35) μg/mL and 22.31 (4.97) μg/mL respectively. The extent of vancomycin removal with 4-hour high-flux HD was 44.31%, but the actual removal of vancomycin taking into consideration of rebound was 22.49% at 6 hours post HD. Three out of eight (37.5%) patients had vancomycin concentration of less than 20 μg/mL 6 hours post HD. A considerable amount of vancomycin is eliminated with high-flux HD. This should be taken into consideration if using pre HD vancomycin level to guide dosing. If feasible, vancomycin concentration 6 hours post HD would be a more accurate guide to prevent under-dosing.