Vancomycin Pharmacokinetics in Oliguric Patients Undergoing Continuous Venovenous Hemodialysis and Continuous Venovenous Hemodiafiltration

Korean Journal of Nephrology 2010;29(5):585-592.

Inwhee Park, M.D.1, Sun A Lee, M.D.2, Seung-Kwan Lim, M.D.3, Sukyong Yu, M.D.1, Eun Jung Jang, M.D.1, Eun Joon Moon, M.D.1, Joo An Hwang, M.D.1, Heungsoo Kim, M.D.1 and Gyu-Tae Shin, M.D.1

Department of Nephrology¹
Department of Pulmonology and Critical Care Medicine³
Ajou University School of Medicine, Suwon, Korea Department of Pharmacy²
Ajou University Hospital, Suwon, Korea

원저 : 지속적정정맥투석요법과 지속적정정맥여과투석을 사용하는 핍뇨 환자에서 vancomycin의 약동학적 변수 관찰

박인휘1, 이선아2, 임승관3, 유수경1, 장은정1, 문은준1, 황주안1, 김흥수1, 신규태1

아주대학교 의과대학 신장내과학교실1 , 아주대학교병원 약제팀2, 아주대학교 의과대학 호흡기내과학교실3

Abstract

Purpose: Critically ill patients receiving continuous renal replacement therapy are susceptible to infection with methicillin-resistant bacteria, which require treatment with vancomycin. However, there are limited reports regarding vancomycin pharmacokinetics in the continuous venovenous hemodialysis (CVVHD) and continuous venovenous hemodiafiltration (CVVHDF). We performed this study to investigate the pharmacokinetics of vancomycin in oliguric patients receiving CVVHD and CVVHDF. Methods: Data at steady-state obtained as part of our routine drug monitoring of vancomycin therapy in critically ill adult oliguric patients undergoing CVVHD or CVVHDF, retrospectively. Data were available for 35 cases of 23 patients assessed for 2 years. We analyzed the pharmacokinetic parameters of these cases. Results: 8 cases on CVVHD and 27 cases on CVVHDF were available. The mean intensity of CVVHD was 17.7±4.9 mL/hour/kg and that of CVVHDF was 32.1±3.9 mL/hour/kg (p=0.000). The mean clearance of vancomycin was 16.4±3.8 mL/min in the CVVHD group and 21.6±5.1 mL/min in the CVVHDF group (P=0.007). The elimination of vancomycin correlated with the intensity of CVVHD and CVVHDF (CVVHD; r2=0.745, p=0.012, CVVHDF; r2=0.452, p=0.000). Conclusion: CVVHD and CVVHDF are effective for vancomycin elimination and there is a strong dependency of the vancomycin removal on the intensity of continuous renal replacement therapy. Strategies for individualization of vancomycin therapy in patients receiving CVVHD and CVVHDF are proposed.

Key Words: Vancomycin, Pharmacokinetics, Renal replacement therapy