A Pharmacokinetic Study Comparing the Clearance of Vancomycin during Haemodialysis Using Medium Cut-Off Membrane (Theranova) and High-Flux Membranes (Revaclear)
Abstract
1. Introduction
2. Results
3. Discussion
4. Conclusions
5. Materials and Methods
5.1. Subjects
5.2. Study Procedure
5.3. Statistics
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
Day | Membrane | Patient | Pre-HD con | 5 min con | % Reduction at 5 min | 15 min con | % Reduction at 15 min | 30 min con | % Reduction at 30 min | 45 min con | % Reduction at 45 min | 120 min con | % Reduction at 120 min |
1 | MCO | 1 | 16.3 | 11 | 32.5 | 11.4 | 30.1 | 9.7 | 40.5 | 9.3 | 42.9 | 7.9 | 51.5 |
2 | HF | 1 | 18.2 | 9.6 | 47.3 | 11.2 | 38.5 | 10.2 | 44.0 | 11.1 | 39.0 | 9.4 | 48.4 |
3 | MCO | 1 | 18.3 | 17.5 | 4.4 | 16.6 | 9.3 | 15.4 | 15.8 | 13.5 | 26.2 | 10.1 | 44.8 |
4 | HF | 1 | 21 | 20.7 | 1.4 | 19.3 | 8.1 | 18.8 | 10.5 | 19.3 | 8.1 | 15 | 28.6 |
5 | MCO | 1 | 10.6 | 10.1 | 4.7 | 9.4 | 11.3 | 8.9 | 16.0 | 9 | 15.1 | 7.7 | 27.4 |
6 | HF | 1 | 16.3 | 15.2 | 6.7 | 15.8 | 3.1 | 14.4 | 11.7 | 13.5 | 17.2 | 12 | 26.4 |
1 | MCO | 2 | 10.7 | 10.1 | 5.6 | 9.7 | 9.3 | 9.9 | 7.5 | 9.6 | 10.3 | 8.5 | 20.6 |
2 | HF | 2 | 18.8 | 17.1 | 9.0 | 16.3 | 13.3 | 15.7 | 16.5 | 15.7 | 16.5 | 13.7 | 27.1 |
3 | MCO | 2 | 12.9 | 12.3 | 4.7 | 12 | 7.0 | 11.6 | 10.1 | 10.6 | 17.8 | 9.9 | 23.3 |
4 | HF | 2 | 18.3 | 16.8 | 8.2 | 16.9 | 7.7 | 15.9 | 13.1 | 15.1 | 17.5 | 14.4 | 21.3 |
5 | MCO | 2 | 21.9 | 21.2 | 3.2 | 21.1 | 3.7 | 19.6 | 10.5 | 19.1 | 12.8 | 17.3 | 21.0 |
6 | HF | 2 | 16.9 | 15 | 11.2 | 14.2 | 16.0 | 14 | 17.2 | 13.8 | 18.3 | 12.7 | 24.9 |
1 | MCO | 3 | 22.6 | 20.5 | 9.3 | 19.1 | 15.5 | 17.2 | 23.9 | 16.5 | 27.0 | 13.6 | 39.8 |
2 | HF | 3 | 12.6 | 11.9 | 5.6 | 10.9 | 13.5 | 10.7 | 15.1 | 10.4 | 17.5 | 8.3 | 34.1 |
3 | MCO | 3 | 20.2 | 18.2 | 9.9 | 17.5 | 13.4 | 15.7 | 22.3 | 15.2 | 24.8 | 13 | 35.6 |
4 | HF | 3 | 21.4 | 19.5 | 8.9 | 17.1 | 20.1 | 16.3 | 23.8 | 15.5 | 27.6 | 13.1 | 38.8 |
5 | MCO | 3 | 14.5 | 11.4 | 21.4 | 10.8 | 25.5 | 9.3 | 35.9 | 9.6 | 33.8 | 7.2 | 50.3 |
6 | HF | 3 | 18 | 16 | 11.1 | 15 | 16.7 | 13.1 | 27.2 | 12.9 | 28.3 | 10.4 | 42.2 |
1 | MCO | 4 | 19.4 | 17.3 | 10.8 | 17.3 | 10.8 | 14.8 | 23.7 | 14.3 | 26.3 | 11.8 | 39.2 |
2 | HF | 4 | 21.9 | 20.3 | 7.3 | 18.4 | 16.0 | 17.4 | 20.5 | 16.5 | 24.7 | 13.2 | 39.7 |
3 | MCO | 4 | 14.4 | 13.3 | 7.6 | 12.6 | 12.5 | 11.1 | 22.9 | 10.9 | 24.3 | 8.5 | 41.0 |
4 | HF | 4 | 16.9 | 14.7 | 13.0 | 13.9 | 17.8 | 13.2 | 21.9 | 12.5 | 26.0 | 11 | 34.9 |
5 | MCO | 4 | 17.5 | 15.3 | 12.6 | 14.5 | 17.1 | 12.7 | 27.4 | 13.3 | 24.0 | 10.6 | 39.4 |
6 | HF | 4 | 19.6 | 17.8 | 9.2 | 16.3 | 16.8 | 15.4 | 21.4 | 14.4 | 26.5 | 10.8 | 44.9 |
1 | MCO | 5 | 8.9 | 7.6 | 14.6 | 7.6 | 14.6 | 1.7 | 80.9 | 6.6 | 25.8 | 5.6 | 37.1 |
2 | HF | 5 | 11.2 | 10.3 | 8.0 | 9.9 | 11.6 | 9.9 | 11.6 | 8.8 | 21.4 | 7.7 | 31.3 |
3 | MCO | 5 | 14.5 | 12.9 | 11.0 | 13.6 | 6.2 | 12 | 17.2 | 13.4 | 7.6 | 9.6 | 33.8 |
4 | HF | 5 | 15.3 | 14.8 | 3.3 | 13.7 | 10.5 | 11.7 | 23.5 | 12.4 | 19.0 | 10.6 | 30.7 |
5 | MCO | 5 | 15.9 | 14.2 | 10.7 | 12.5 | 21.4 | 12.7 | 20.1 | 12.6 | 20.8 | 9.7 | 39.0 |
6 | HF | 5 | 18.4 | 16.3 | 11.4 | 14.6 | 20.7 | 13.8 | 25.0 | 14.1 | 23.4 | 11.4 | 38.0 |
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Characteristic | Number of Patient (%) |
---|---|
Sex | |
Female | 4 (80) |
Age | |
≤65 | 3 (60) |
Ethnicity | |
Maori | 4 (80) |
Caucasian | 1 (20) |
BMI | |
≤30 | 2 (40) |
Access used | |
Fistula/Graft | 2 (40) |
Central lines tunneled or temporary | 5 (60) |
Bloods Flow (pump velocity) mL/min, per session | |
≤250 | 16 sessions (53.3) |
>250 | 14 sessions (46.7) |
Use of loop diuretics | 3 (60) |
Use of ACEi or ARB | 1 (20) |
Patients with vancomycin trough ≥15 mg/L on day 1 | 3 (60) |
Number of iHD per week = 3 | 5 (100) |
Duration of HD per session | |
≤240min | 1 (20) |
>240min | 4 (80) |
Patient | Indication for Treatment |
---|---|
1 | Dialysis Tunnelled central line sepsis |
2 | Peritoneal Dialysis catheter exit site infection with MRSA |
3 | Dialysis Tunnelled central line sepsis |
4 | Coagulase negative staphylococcus species bacteraemia |
5 | Cellulitis/Infected synthetic Arteriovenous Graft |
Patient Variable | Median Study Percentage Reduction (%) | Median High-Flux Membrane Percentage Reduction (%) | Median Medium Cut-Off Membrane Percentage Reduction (%) | |
---|---|---|---|---|
BMI (kg/m2) | <30 | 39.3 | 36.5 | 42.5 |
≥30 | 34.4 | 31.3 | 37.1 | |
Qb (mL/min) | ≤250 | 31.3 | 31.3 | 31.3 |
>250 | 38.5 | 34.9 | 39.2 | |
Vancomycin concentration at start of HD (mg/L) | <15 | 33.8 | 32.7 | 33.8 |
≥15 | 38.8 | 34.9 | 39.3 | |
Vancomycin concentration at start of HD (mg/L) | <18 | 34 | 31 | 38 |
≥18 | 39 | 38.8 | 39.2 | |
Loop diuretics | Yes | 38.5 | 34.9 | 39.2 |
No | 30.6 | 30.6 | 29.4 | |
ACEi/ARB | Yes | 36.7 | 28.6 | 44.8 |
No | 36.4 | 34.5 | 38 | |
Interval between HD session (Hours) | ≤48 | 37.6 | 34.9 | 39.2 |
>48 (i.e., 72hs) | 34.9 | 32.7 | 37.3 | |
Interval between doses (Hours) | ≤48 | 36 | 34.9 | 37.1 |
>48 (i.e., 72hs) | 37.2 | 32.7 | 39.2 | |
Duration on HD (minutes) | ≤240 | 37.1 | 31.3 | 38 |
>240 | 35.6 | 34.5 | 39.2 |
Variable | Estimate | Concentration Ratio |
---|---|---|
(Intercept or Baseline) | −0.43 | NA |
Medium cut-off membrane | −0.04 | 0.96 |
Use of loop diuretic | 0.05 | 1.05 |
Blood flow of dialysis (per mL/min) | −0.001 | 1.00 |
BMI (per kg/m2) | 0.01 | 1.01 |
Loading Dose | Infusion Duration |
---|---|
750 mg | 60 min |
1000 mg | 60 min |
1250 mg | 90 min |
1500 mg | 90 min |
1750 mg | 120 min |
2000 mg | 120 min |
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Allawati, H.; Dallas, L.; Nair, S.; Palmer, J.; Thaikandy, S.; Hutchison, C. A Pharmacokinetic Study Comparing the Clearance of Vancomycin during Haemodialysis Using Medium Cut-Off Membrane (Theranova) and High-Flux Membranes (Revaclear). Toxins 2020, 12, 317. https://doi.org/10.3390/toxins12050317
Allawati H, Dallas L, Nair S, Palmer J, Thaikandy S, Hutchison C. A Pharmacokinetic Study Comparing the Clearance of Vancomycin during Haemodialysis Using Medium Cut-Off Membrane (Theranova) and High-Flux Membranes (Revaclear). Toxins. 2020; 12(5):317. https://doi.org/10.3390/toxins12050317
Chicago/Turabian StyleAllawati, Hussain, Linda Dallas, Sreejith Nair, Janine Palmer, Shaiju Thaikandy, and Colin Hutchison. 2020. "A Pharmacokinetic Study Comparing the Clearance of Vancomycin during Haemodialysis Using Medium Cut-Off Membrane (Theranova) and High-Flux Membranes (Revaclear)" Toxins 12, no. 5: 317. https://doi.org/10.3390/toxins12050317
APA StyleAllawati, H., Dallas, L., Nair, S., Palmer, J., Thaikandy, S., & Hutchison, C. (2020). A Pharmacokinetic Study Comparing the Clearance of Vancomycin during Haemodialysis Using Medium Cut-Off Membrane (Theranova) and High-Flux Membranes (Revaclear). Toxins, 12(5), 317. https://doi.org/10.3390/toxins12050317