Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014, 158(1):065-072 | DOI: 10.5507/bp.2012.092

Vancomycin pharmacokinetics during high-volume continuous venovenous hemofiltration in critically ill septic patients

Nadezda Petejova^a, Arnost Martinek^a, Jana Zahalkova^b,c, Jana Duricova^d, Hana Brozmannova^d, Karel Urbanek^e, Milan Grundmann^d, Jiri Plasek^a, Ivana Kacirova^d

^a Department of Internal Medicine, Faculty of Medicine, University of Ostrava and University Hospital Ostrava, Czech Republic

^b Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc

^c Stredomoravska nemocnicni, Hospital Sternberk

^d Department of Clinical Pharmacology, Faculty of Medicine and University Hospital Ostrava

^e Department of Clinical Pharmacology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc

Aims: To assess the influence of continuous venovenous hemofiltration (CVVH) at a filtration rate of 45 mL/kg/h on vancomycin pharmacokinetics in critically ill septic patients with acute kidney injury (AKI).

Methods: Seventeen adult septic patients with acute kidney injury treated with CVVH and vancomycin were included. All patients received first dose of 1.0 g intravenously followed by 1.0 g/12 h if not adjusted. In sixteen patients vancomycin was introduced on the day of the start of CRRT therapy. Blood samples and ultrafiltrates were obtained before and 0.5, 1, 6 and 12 h after vancomycin administration.

Results: On the first day, the median total vancomycin clearance (Cl_tot) was 0.89 mL/min/kg (range 0.31 - 2.16). CRRT clearance accounted for around 50-60% of the total clearance of vancomycin found in a population with normal renal function (0.97 mL/min/kg). Vancomycin serum concentrations after the first dose were below the required target of 10 mg/L as early as 6 h in 10 patients, AUC_0-24/MIC ≥ 400 ratio was achieved in 10 patients on the first day.

Conclusions: CVVH at a filtration rate of 45 mL/kg/h leads to high and rapid extracorporeal removal of vancomycin in critically ill patients. Due to the rapid change in patient clinical status it was impossible to predict a fixed dosage regimen. We recommend blood sampling as early as 6 h after first vancomycin dose with maintenance dose based on vancomycin serum level monitoring.

Keywords: acute kidney injury, critically ill patients, renal replacement therapy, sepsis, drug monitoring, vancomycin

Received: April 16, 2012; Prepublished online: November 6, 2012; Published: April 1, 2014  Show citation