Effects of dialysis membrane on intradialytic vancomycin administration.

STUDY OBJECTIVE

To quantify the influence of hemodialyzers on vancomycin removal when the drug was infused during hemodialysis.

DESIGN

Prospective, controlled, crossover study with three arms.

SETTING

A university-affiliated medical center.

PATIENTS

Eight subjects receiving outpatient hemodialysis.

INTERVENTIONS

The three treatment arms were vancomycin 1000 mg infused after dialysis was completed (control), and the same dosages infused during the last hour of hemodialysis with a cellulose triacetate (CT) and a cellulose acetate (CA) hemodialyzer.

MEASUREMENTS AND MAIN RESULTS

The areas under the curve from time zero to 44 hours (AUC0-44 hrs) for the three study arms were significantly different (p < 0.05), with the mean vancomycin AUC0-44 hrs being significantly lower when administered during CT and CA dialysis (73.7% and 87.2% of control; p < 0.05 vs control). The mean vancomycin peak concentration achieved during CT dialysis was significantly lower than for the CA and control arms (20.5, 23.9, 27.0 mg/L, respectively). Forty-four-hour postinfusion concentrations were similarly lower.

CONCLUSION

Clinicians should recognize that the composition of the hemodialyzer significantly influences vancomycin serum concentrations when the drug is administered during hemodialysis.