El Nekidy Wasim S, El-Masri Maher M, Umstead Greg S, Dehoorne-Smith Michelle
PharmD, BCPS, BCACP, was, at the time of this study, a Resident at St John Hospital and Medical Center in Detroit, Michigan. At the time of submission, he was a Clinical Pharmacy Specialist with the Departments of Pharmacy and Nephrology, Windsor Regional Hospital, Windsor, Ontario, and he is now a Senior Pharmacotherapy Specialist - Nephrology with the Department of Pharmacy, Cleveland Clinic Abu Dhabi, United Arab Emirates.
PhD, RN, is Professor and Research Leadership Chair, Faculty of Nursing, University of Windsor, Windsor, Ontario.
Can J Hosp Pharm. 2016 Sep-Oct;69(5):341-347. doi: 10.4212/cjhp.v69i5.1588. Epub 2016 Oct 31.
Methicillin-resistant is a leading cause of death in patients undergoing hemodialysis. However, controversy exists about the optimal dose of vancomycin that will yield the recommended pre-hemodialysis serum concentration of 15-20 mg/L.
To develop a data-driven model to optimize the accuracy of maintenance dosing of vancomycin for patients undergoing hemodialysis.
A prospective observational cohort study was performed with 164 observations obtained from a convenience sample of 63 patients undergoing hemodialysis. All vancomycin doses were given on the floor after completion of a hemodialysis session. Multivariate linear generalized estimating equation analysis was used to examine independent predictors of pre-hemodialysis serum vancomycin concentration.
Pre-hemodialysis serum vancomycin concentration was independently associated with maintenance dose ( = 0.658, < 0.001), baseline pre-hemodialysis serum concentration of the drug ( = 0.492, < 0.001), and interdialytic interval ( = -2.133, < 0.001). According to the best of 4 models that were developed, the maintenance dose of vancomycin required to achieve a pre-hemodialysis serum concentration of 15-20 mg/L, if the baseline serum concentration of the drug was also 15-20 mg/L, was 5.9 mg/kg with interdialytic interval of 48 h and 7.1 mg/kg with interdialytic interval of 72 h. However, if the baseline pre-hemodialysis serum concentration was 10-14.99 mg/L, the required dose increased to 9.2 mg/kg with an interdialytic interval of 48 h and 10.0 mg/kg with an interdialytic interval of 72 h.
The maintenance dose of vancomycin varied according to baseline pre-hemodialysis serum concentration of the drug and interdialytic interval. The current practice of targeting a pre-hemodialysis concentration of 15-20 mg/L may be difficult to achieve for the majority of patients undergoing hemodialysis.
耐甲氧西林金黄色葡萄球菌是血液透析患者死亡的主要原因。然而，对于能产生推荐的血液透析前血清浓度15 - 20毫克/升的万古霉素最佳剂量存在争议。
建立一个数据驱动模型，以优化血液透析患者万古霉素维持剂量的准确性。
进行了一项前瞻性观察队列研究，从63例接受血液透析的患者的便利样本中获得164个观察数据。所有万古霉素剂量均在血液透析 session 结束后在病房给予。采用多变量线性广义估计方程分析来检查血液透析前血清万古霉素浓度的独立预测因素。
血液透析前血清万古霉素浓度与维持剂量（β = 0.658，P < 0.001）、药物的基线血液透析前血清浓度（β = 0.492，P < 0.001）和透析间期（β = -2.133，P < 0.001）独立相关。根据所建立的4个模型中最佳的模型，如果药物的基线血清浓度也为15 - 20毫克/升，要达到血液透析前血清浓度为$15 - 20$毫克/升，透析间期为48小时时万古霉素的维持剂量为5.9毫克/千克，透析间期为72小时时为7.1毫克/千克。然而，如果基线血液透析前血清浓度为10 - 14.99毫克/升，透析间期为48小时时所需剂量增加到9.2毫克/千克，透析间期为72小时时为10.0毫克/千克。
万古霉素的维持剂量根据药物的基线血液透析前血清浓度和透析间期而有所不同。对于大多数接受血液透析的患者来说，目前将血液透析前浓度目标设定为15 - 20毫克/升的做法可能难以实现。
