Anita Gofran, Julie Chen, Ladan Golestaneh. Medicine, Renal Division, Montefiore Medical Center, Bronx, NY
Objective: To determine the extent of vancomycin clearance (CLV) in patients (pts) receiving SLED.
Secondary Objective: To determine if current vancomycin dosing practice is appropriate in maintaining optimal concentration in pts receiving SLED.
Introduction: Vancomycin is a commonly used antibiotic in critically ill pts. The half life (t1/2) is 8 hours(hrs) in pts with normal renal function and may approach 1 week or longer in those with an estimated glomerular filtration rate of <10 mL/min. Studies in pts undergoing hemodialysis have shown that 30% to 40% of vancomycin is cleared with a t1/2 of 5.4 hrs during a high flux hemodialysis treatment. The CLV is dependent on the blood flow rate (BFR) but not the surface area of the dialyzer. SLED is a hybrid dialysis technique that has been increasingly used in the intensive care units (ICU) to support hemodynamically unstable pts with renal failure. The aim of this study was to evaluate the CLV in ICU pts with oliguric renal failure undergoing SLED.
Design: Prospective clinical study Methods: We studied 10 adult ICU pts receiving vancomycin for more than 48 hrs with oliguric acute renal failure or chronic ESRD, requiring SLED treatment. SLED was performed with a polysulfone dialyzer (AV400) for a minimum of 8 hrs. Blood flow rate, dialysate flow rate (DFR), and ultrafiltration flow rate (UFR) were decided on clinical grounds. Blood was collected from the arterial port of the dialysis line at time 0, 2, 4 and 8 hrs into SLED treatment. A central laboratory measured vancomycin levels and CLV was estimated based on these values. Results: CLV was 36%6.5. Estimated t1/2 was 12.92.8 hrs. 80% of pts enrolled were female, and dialysis parameters between pts differed: mean BFR 165mL/min34, DFR 175mL/min42, and UFR 210mL/hr86. CLV was dependent on BFR. 40% of all pts had subtherapeutic values by the end of SLED treatment (level <15mcg/mL).
Conclusion: Vancomycin is significantly removed during a typical 8 hr SLED session. CLV is related to the BFR. Vancomycin levels should be checked after a SLED treatment. Some pts will require a redose of vancomycin to maintain an optimal therapeutic level.
Presented at the American Society of Nephrology Renal Week 2007, San Francisco, California