Effect of Anti-embolism Stocking on Intrasession Hemodynamic Variables in Hemodialysis Patients

Korean Journal of Nephrology 2010;29(5):593-599.

Deok Young Kim, M.D., Seoung Woo Lee, M.D., Su Hyun Kwon, M.D., Joon Ho Song, M.D. and Moon-Jae Kim, M.D.

Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea

원저 : 혈액투석 환자에서 혈액투석 중 항색전 스타킹 착용이 혈역동학 변수들에 미치는 영향

김덕영, 이승우, 권수현, 송준호, 김문재

인하대학교 의학전문대학원 내과학교실 신장내과

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: Compression stockings, Cardiovascular physiological phenomena, Hemodialysis, End stage renal disease