Aim: The aim of the study was to investigate the efficacy of vancomycin, when administered at a specific dose before the end of the dialysis session, in achieving therapeutic serum levels for the treatment of fistula infections or permanent venous catheter exit site infections. Patients-Methods: Sixteen hemodialyzed patients (6 men and 10 women), with a median age of 77 years (range 44 - 89), who were on predilution online hemodiafiltration, were studied. The diagnosis of infections was made using laboratory findings, clinical findings, and local clinical imaging. The dose of vancomycin given depended on the body weight of each patient (grouped). Vancomycin levels were measured both in serum (before and after the end of the dialysis session) and in the ultrafiltrate, which was collected in a specific barrel. In patients with residual renal function, urea and creatinine were determined in serum, as well as in urine from a 44-hour collection (to determine the patients’ urea and creatinine clearances). Total protein and serum albumin levels were also determined (before and after the end of the dialysis session). Results: The patients were divided into 3 groups: Group A with 6 anuric patients, where the ultrafiltrate was collected only during vancomycin administration; Group B with 5 non-anuric patients with residual renal function (renal clearance from 0.865 to 6.45 ml/min), where again the ultrafiltrate was collected only during vancomycin administration; and Group C with 5 anuric patients, where the ultrafiltrate was collected throughout the whole dialysis session. In 34/64 serum samples which were taken before any dialysis session (after 44 or 68 hours of the previous vancomycin infusion), the serum vancomycin levels were subtherapeutic (<10 mg/L [where in 5 samples these were <5 mg/L]), while in 30/64 they were therapeutic (>10 mg/L). The results also showed that the serum levels of vancomycin 44 hours after the infusion did not differ from those on the day after the long interval between dialysis sessions (Wednesday or Thursday) (p = NS). Also, in serum vancomycin levels at the end of any infusion from the second to the fifth, 9 samples were higher and 3 lower than the desired levels. In the patients with residual renal function, after 68 hours, the serum levels of vancomycin were not lower than those in anuric patients (p = NS), except for one with relatively increased renal clearance. The presence of hypoalbuminemia was found to be associated with lower serum levels of vancomycin
References
[1]
Barth, R.H. and DeVincenzo, N. (1996) Use of Vancomycin in High-Flux Hemodialysis: Experience with 130 Courses of Therapy. KidneyInternational, 50, 929-936. https://doi.org/10.1038/ki.1996.393
[2]
Launay-Vacher, V., Izzedine, H., Mercadal, L. and Deray, G. (2002) Clinical Review: Use of Vancomycin in Haemodialysis Patients. Critical Care, 6, 313-316.
[3]
Pai, A.B. and Pai, M.P. (2004) Vancomycin Dosing in High Flux Hemodialysis: A Limited-Sampling Algorithm. American Journal of Health-System Pharmacy, 61, 1812-1816. https://doi.org/10.1093/ajhp/61.17.1812
[4]
Rybak, M., Lomaestro, B., Rotschafer, J.C., Moellering, R., Craig, W., Billeter, M., et al. (2009) Therapeutic Monitoring of Vancomycin in Adult Patients: A Consensus Review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. American Journal of Health-System Pharmacy, 66, 82-98. https://doi.org/10.2146/ajhp080434
[5]
Roberts, D.M., Liu, X., Roberts, J.A., Nair, P., Cole, L., Roberts, M.S., et al. (2015) A Multicenter Study on the Effect of Continuous Hemodiafiltration Intensity on Antibiotic Pharmacokinetics. Critical Care, 19, Article No. 84. https://doi.org/10.1186/s13054-015-0818-8
[6]
Scott, M.K., Macias, W.L., Kraus, M.A., Clark, W.R., Carfagna, M.A. and Mueller, B.A. (1997) Effects of Dialysis Membrane on Intradialytic Vancomycin Administration. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 17, 256-262. https://doi.org/10.1002/j.1875-9114.1997.tb03707.x
[7]
Ghouti-terki, L., Chasseuil, E., Rabot, N., Paintaud, G., François, M., Birmelé, B., et al. (2017) Vancomycin during the Last Hour of the Hemodialysis Session: A Pharmacokinetic Analysis. Nephron, 135, 261-267. https://doi.org/10.1159/000453005
[8]
Zelenitsky, S.A., Ariano, R.E., McCrae, M.L. and Vercaigne, L.M. (2012) Initial Vancomycin Dosing Protocol to Achieve Therapeutic Serum Concentrations in Patients Undergoing Hemodialysis. Clinical Infectious Diseases, 55, 527-533. https://doi.org/10.1093/cid/cis458
[9]
Nyman, H.A., Agarwal, A., Senekjian, H.O., Leypoldt, J.K. and Cheung, A.K. (2018) Removal of Vancomycin Administered during Dialysis by a High-Flux Dialyzer. Hemodialysis International, 22, 383-387. https://doi.org/10.1111/hdi.12637
[10]
Canaud, B., Koehler, K., Bowry, S. and Stuard, S. (2017) What Is the Optimal Target Convective Volume in On-Line Hemodiafiltration Therapy? In: Contributions to Nephrology, S. Karger AG, 9-16. https://doi.org/10.1159/000450634
[11]
Chong, C.H., Au, E.H., Davies, C.E., Jaure, A., Howell, M., Lim, W.H., et al. (2023) Long-Term Trends in Infection-Related Mortality in Adults Treated with Maintenance Dialysis. American Journal of Kidney Diseases, 82, 597-607. https://doi.org/10.1053/j.ajkd.2023.03.018
[12]
Vandecasteele, S.J., Boelaert, J.R., Vriese, D. and An, S. (2009) Staphylococcus aureus Infections in Hemodialysis: What a Nephrologist Should Know. ClinicalJournaloftheAmericanSocietyofNephrology, 4, 1388-1400. https://doi.org/10.2215/cjn.01590309
[13]
Zaric, R.Z., Milovanovic, J., Rosic, N., Milovanovic, D., Zecevic, D.R., Folic, M., et al. (2018) Pharmacokinetics of Vancomycin in Patients with Different Renal Function Levels. Open Medicine, 13, 512-519. https://doi.org/10.1515/med-2018-0068
[14]
Golper, T.A., Noonan, H.M., Elzinga, L., Gilbert, D., Brummett, R., Anderson, J.L., et al. (1988) Vancomycin Pharmacokinetics, Renal Handling, and Nonrenal Clearances in Normal Human Subjects. Clinical Pharmacology and Therapeutics, 43, 565-570. https://doi.org/10.1038/clpt.1988.74
[15]
Rodvold, K.A., Blum, R.A., Fischer, J.H., Zokufa, H.Z., Rotschafer, J.C., Crossley, K.B., et al. (1988) Vancomycin Pharmacokinetics in Patients with Various Degrees of Renal Function. Antimicrobial Agents and Chemotherapy, 32, 848-852. https://doi.org/10.1128/aac.32.6.848
[16]
Ye, Z.K., Tang, H.L. and Zhai, S.D. (2013) Benefits of Therapeutic Drug Monitoring of Vancomycin: A Systematic Review and Meta-Analysis. PLOSONE, 8, e77169. https://doi.org/10.1371/journal.pone.0077169
[17]
Geraci, J.E. (1977) Vancomycin. Mayo Clinic Proceedings, 52, 631-634. https://doi.org/10.1016/s0025-6196(25)09907-0
[18]
Sakoulas, G., Gold, H.S., Cohen, R.A., Venkataraman, L., Moellering, R.C. and Eliopoulos, G.M. (2006) Effects of Prolonged Vancomycin Administration on Methicillin-Resistant Staphylococcus aureus (MRSA) in a Patient with Recurrent Bacteraemia. Journal of Antimicrobial Chemotherapy, 57, 699-704. https://doi.org/10.1093/jac/dkl030
[19]
Vandecasteele, S.J. and De Vriese, A.S. (2010) Recent Changes in Vancomycin Use in Renal Failure. Kidney International, 77, 760-764. https://doi.org/10.1038/ki.2010.35
[20]
Helgason, K.O., Thomson, A.H. and Ferguson, C. (2008) A Review of Vancomycin Therapeutic Drug Monitoring Recommendations in Scotland. Journal of Antimicrobial Chemotherapy, 61, 1398-1399. https://doi.org/10.1093/jac/dkn114
[21]
Jager, N.G.L., Zandvliet, A.S., Touw, D.J. and Penne, E.L. (2017) Optimization of Anti-Infective Dosing Regimens during Online Haemodiafiltration. Clinical Kidney Journal, 10, 282-290. https://doi.org/10.1093/ckj/sfx009
[22]
Blot, S.I., Pea, F. and Lipman, J. (2014) The Effect of Pathophysiology on Pharmacokinetics in the Critically Ill Patient—Concepts Appraised by the Example of Antimicrobial Agents. Advanced Drug Delivery Reviews, 77, 3-11. https://doi.org/10.1016/j.addr.2014.07.006
[23]
Taylor, M.E. and Allon, M. (2010) Practical Vancomycin Dosing in Hemodialysis Patients in the Era of Emerging Vancomycin Resistance: A Single-Center Experience. American Journal of Kidney Diseases, 55, 1163-1165. https://doi.org/10.1053/j.ajkd.2010.03.016
[24]
Khodabandehloo, N., Fourodi, A. and Jenabi, A. (2019) Vancomycin Dosing in Low-Flux Hemodialysis; Is Adjustment of Drug Dosage Necessary? Journal of Renal Injury Prevention, 8, 112-115. https://doi.org/10.15171/jrip.2019.21
[25]
Lewis, S.J. and Nolin, T.D. (2021) New Vancomycin Dosing Guidelines for Hemodialysis Patients: Rationale, Caveats, and Limitations. Kidney 360, 2, 1313-1315. https://doi.org/10.34067/kid.0000192021
[26]
Hui, K., Patel, K., Nalder, M., Nelson, C., Buising, K., Pedagogos, E., et al. (2019) Optimizing Vancomycin Dosage Regimens in Relation to High-Flux Haemodialysis. Journal of Antimicrobial Chemotherapy, 74, 130-134. https://doi.org/10.1093/jac/dky371
[27]
Soto Guerrero, Y., Hernández Castillo, R., Santiago, E., Santiago, E., Yuch, N.R., Anselmi, F.J., et al. (2012) Evaluation of a Vancomycin Dosing Regimen for Patients on High-Flux Hemodialysis: An Observational Study. Boletín de la Asociación Médica de Puerto Rico, 104, 10-14.
[28]
Rybak, M.J., Le, J., Lodise, T.P., Levine, D.P., Bradley, J.S., Liu, C., et al. (2020) Therapeutic Monitoring of Vancomycin for Serious Methicillin-Resistant Staphylococcusaureus Infections: A Revised Consensus Guideline and Review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. AmericanJournalofHealth-SystemPharmacy, 77, 835-864. https://doi.org/10.1093/ajhp/zxaa036
[29]
Edell, L.S., Westby, G.R. and Gould, S.R. (1988) An Improved Method of Vancomycin Administration to Dialysis Patients. Clinical Nephrology, 29, 86-87.
[30]
Foote, E.F., Dreittlein, W.B., Seward, C.A., Kapoian, T., Walker, S.A. and Sherman, R.A. (1998) Pharmacokinetics of Vancomycin When Administered during High Flux Haemodialysis. Clinical Nephrology, 50, 51-55.
[31]
Westra, N., Proost, J.H., Franssen, C.F.M., Wilms, E.B., van Buren, M. and Touw, D.J. (2019) Vancomycin Pharmacokinetic Model Development in Patients on Intermittent Online Hemodiafiltration. PLOS ONE, 14, e0216801. https://doi.org/10.1371/journal.pone.0216801
[32]
Rodríguez, N., Gómez, M., Rico, N., María Campistol, J. and Maduell, F. (2019) Vancomycin Hemodialysis: Clearance Differences between High-Flux Hemodialysis and Online Hemodiafiltration. Artificial Organs, 43, 261-269. https://doi.org/10.1111/aor.13368
[33]
Bravo, J.J., Díaz, A., Donado, E., Tarragó, J., Tato, F., Romero, R., et al. (2005) Behavior of Vancomycin with the New Techniques in Hemodialysis. Nefrologia, 25, 527-534.
