Vancomycin removal by high-flux polysulfone hemodialysis membranes in critically ill patients with end-stage renal disease

Abstract

To define the pharmacokinetics of vancomycin in patients undergoing maintenance hemodialysis in an acute care setting and to characterize the rebound phenomenon occurring after hemodialysis, vancomycin t 1 2 during the interdialytic and intradialytic phases and intradialytic clearance were measured in eight critically ill patients undergoing high-flux hemodialysis using F-80 or F-60 polysulfone dialyzers. Intradialytic clearance was determined using the recovery method. In patients dialyzed with F-80 dialyzers, interdialytic and intradialytic t 1 2 for vancomycin were 162 ± 69.8 hours and 4.7 ± 1.3 hours, respectively. Intradialytic clearance was 108.5 ± 16.3 mL/min, and 238 ± 55 mg of vancomycin was recovered in the dialysate. In patients dialyzed with F-60 dialyzers, interdialytic and intradialytic t 1 2 were 211.0 ± 166.8 and 4.6 ± 0.4 hours, respectively. Intradialytic clearance was 100.6 ± 18.3 mL/min and the amount of vancomycin recovered was 252 ± 79 mg. Vancomycin concentrations rebounded by 16% to 37% between 3 and 6 hours in patients dialyzed with the F-80 dialyzer and 15% to 38% between 2 and 3 hours in patient dialyzed with F-60 dialyzers. Hemodialysis with high-flux polysulfone dialyzers removes significant amounts of vancomycin in patients dialyzed in an acute care setting. A suggested scheme for vancomycin dosage adjustments in these patients is presented.