Department of Medicine, Montefiore Medical Center, The University Hospital for the Albert Einstein College of Medicine, Bronx, NY 10467, USA.
Nephrol Dial Transplant. 2010 Aug;25(8):2632-6. doi: 10.1093/ndt/gfq090. Epub 2010 Feb 24.
The purpose of this study was to examine the removal of meropenem during an 8-h sustained low-efficiency dialysis (SLED) session. Using a minimum inhibitory concentration (MIC) = 2 microg/mL as our reference point, we also evaluated the therapeutic adequacy of dosing meropenem as 1 g every 12 h during SLED.
This was a prospective, open-label study involving 10 intensive care unit patients with renal failure needing SLED. Meropenem was dosed as 1 g every 12 h. To ensure a steady state, the patients received at least two doses prior to the study. SLED was initiated at least 2 h after the last meropenem dose, and each session was at least 8 h. Blood samples were collected during SLED at 0, 2, 4 and 8 h. The 8-h sample approximated the trough level. After centrifuging the samples, the supernatants were analysed by high-performance liquid chromatography.
Most patients were male with a mean age of 63.7 years and a mean weight of 88.9 kg. The SLED prescription was based on each patient's needs, and the blood flow, dialysate flow and ultrafiltration rates varied by up to 150 mL/min. The mean reduction of plasma meropenem concentration was 79.1 +/- 7.3%, and the mean half-life was 3.6 +/- 0.8 h during the 8-h SLED. Significantly more meropenem was removed in the first 4 h of SLED compared with the rest of the sessions. The mean plasma trough concentration was 4 +/- 1.6 microg/mL.
Meropenem was significantly removed from the blood compartment during SLED. Dosing 1 g of meropenem every 12 h during a typical 8-h SLED session maintains adequate plasma concentrations.
本研究旨在考察在 8 小时持续低效透析（SLED）过程中美罗培南的清除情况。以最低抑菌浓度（MIC）=2μg/ml 作为参考点，我们还评估了在 SLED 期间每 12 小时给予 1 克美罗培南作为剂量的治疗效果。
这是一项前瞻性、开放标签的研究，涉及 10 例需要 SLED 的肾衰竭重症监护病房患者。美罗培南的剂量为每 12 小时 1 克。为了确保达到稳定状态，患者在研究前至少接受了两次剂量。SLED 至少在最后一次美罗培南给药后 2 小时开始，每个疗程至少 8 小时。在 SLED 过程中，分别在 0、2、4 和 8 小时采集血样。8 小时的样本接近谷值水平。采集样本后离心，上清液通过高效液相色谱法进行分析。
大多数患者为男性，平均年龄为 63.7 岁，平均体重为 88.9 公斤。SLED 处方根据每个患者的需求制定，血流、透析液流量和超滤率的变化可达 150ml/min。美罗培南的血浆浓度平均降低 79.1%±7.3%，在 8 小时的 SLED 过程中平均半衰期为 3.6±0.8 小时。与其余疗程相比，SLED 的前 4 小时内明显去除了更多的美罗培南。平均血浆谷浓度为 4±1.6μg/ml。
美罗培南在 SLED 过程中从血液中明显被清除。在典型的 8 小时 SLED 期间，每 12 小时给予 1 克美罗培南的剂量可维持足够的血浆浓度。
