Abstract
To determine the extent of vancomycin removal and vancomycin pharmacokinetics in septic patients with AKI using daily hemodialysis with polysulphone high-flux and low-flux membrane. Five patients received 6 h daily dialysis with low-flux polysulphone membrane, four patients with high-flux polysulphone membrane. Vancomycin was administered over the last hour of dialysis. The maintenance dose was adjusted based on pre-hemodialysis serum concentrations. Patients were followed up for two days. Median percentage of vancomycin removal by low-flux membrane dialysis was 17% (8-38%) and by high-flux membrane dialysis was 31% (13-43%). Vancomycin clearance was only moderately higher in high-flux membrane dialysis (median 3.01 L/h, range 2.34-3.5 L/h) compared to low-flux dialysis (median 2.48 L/h, range 0.53-5.68 L/h) in the first day of the study. About two-fold higher vancomycin clearance in high-flux dialysis (median 3.62 L/h, range 1.37-5.07 L/h) was observed on the second day of the study than low-flux dialysis (median 1.74 L/h, range 0.75-30.94 L/h). Both high-flux and low-flux membrane dialysis remove considerable amounts of vancomycin in critically ill septic patients with AKI. Application of vancomycin after each dialysis was required to maintain therapeutic concentrations.
Highlights
Sepsis and septic shock are frequent causes of patients’ admission to intensive care units: They often lead to multiple organ dysfunction syndrome with acute kidney injury (AKI).The incidence of AKI in septic patients is up to 51% and severe AKI requiring RRT occurs in 5%
Two modalities of RRT are possible in the treatment of septic patients with AKI: either intermittent hemodialysis (IHD) or continual renal replacement therapy (CRRT)
68% of vancomycin was removed by low-flux membrane dialysis on the second day of the study and intradialytic clearance was 30.94 L/h
Summary
Sepsis and septic shock are frequent causes of patients’ admission to intensive care units: They often lead to multiple organ dysfunction syndrome with acute kidney injury (AKI) (ref.[1]).The incidence of AKI in septic patients is up to 51% and severe AKI requiring RRT (renal replacement therapy) occurs in 5% (ref.[2]). In patients with sepsis, sustained oliguria or severe metabolic acidosis may be reason enough to start RRT as these patients often do not manifest signs of azotemia[4]. Two modalities of RRT are possible in the treatment of septic patients with AKI: either intermittent hemodialysis (IHD) or continual renal replacement therapy (CRRT). New RRT modalities like the hybrid method SLEDD (slow efficiency daily dialysis) and EDD (extended daily dialysis) have been used in the treatment of critically ill patients. The Surviving Sepsis Campaign recommends that intravenous antibiotics are begun within the first hour after diagnosis of severe sepsis and septic shock[6]
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