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Clinical review: use of vancomycin in haemodialysis patients.

Launay-Vacher V, Izzedine H, Mercadal L, Deray G - Crit Care (2002)

Bottom Line: Furthermore, vancomycin easily diffuses through dialysis membranes.The aim of the present review is to establish guidelines for handling this drug in such patients.We indicate how and when plasma concentrations of vancomycin should be determined in dialysis patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Pitie-Salpetriere Hospital, Paris, France. vincent.launay-vacher@psl.ap-hop-paris.fr

ABSTRACT
Following intravenous administration, vancomycin is poorly metabolized and is mainly excreted unchanged in urine. Total body clearance is thus dependent on the kidney, and is correlated with glomerular filtration rate and creatinine clearance. Accumulation of vancomycin in patients with renal insufficiency may therefore occur, and this may lead to toxic side effects if dosage is not modified according to the degree of renal failure. Furthermore, vancomycin easily diffuses through dialysis membranes. The aim of the present review is to establish guidelines for handling this drug in such patients. We indicate how and when plasma concentrations of vancomycin should be determined in dialysis patients.

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Related in: MedlinePlus

Vancomycin pharmacokinetic profile during chronic haemodialysis: evidence for a postsession rebound in plasma concentration. Reproduced with permission from Welage et al. [22].
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Figure 1: Vancomycin pharmacokinetic profile during chronic haemodialysis: evidence for a postsession rebound in plasma concentration. Reproduced with permission from Welage et al. [22].

Mentions: Studies of the pharmacokinetics of vancomycin in patients undergoing haemodialysis with high flux membranes demonstrated that there is a rebound in vancomycin plasma concentrations at the end of the session. The plasma profile of vancomycin concentrations versus time indicates that concentrations decrease dramatically during the session and then increase when the session is stopped for 3–6 hours (Fig. 1). This rebound may result from drug recirculation from plasma protein binding sites. Recirculation from peripheral compartments is less likely to occur because of the low vancomycin volume of distribution, indicating that the drug remains mainly in plasma. This rebound may be clinically significant, and it must be taken into account when determining vancomycin trough levels. Subsequently, it is recommended that determination of vancomycin trough levels in patients undergoing chronic haemodialysis should be performed before the haemodialysis session (Table 2).


Clinical review: use of vancomycin in haemodialysis patients.

Launay-Vacher V, Izzedine H, Mercadal L, Deray G - Crit Care (2002)

Vancomycin pharmacokinetic profile during chronic haemodialysis: evidence for a postsession rebound in plasma concentration. Reproduced with permission from Welage et al. [22].
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC137311&req=5

Figure 1: Vancomycin pharmacokinetic profile during chronic haemodialysis: evidence for a postsession rebound in plasma concentration. Reproduced with permission from Welage et al. [22].
Mentions: Studies of the pharmacokinetics of vancomycin in patients undergoing haemodialysis with high flux membranes demonstrated that there is a rebound in vancomycin plasma concentrations at the end of the session. The plasma profile of vancomycin concentrations versus time indicates that concentrations decrease dramatically during the session and then increase when the session is stopped for 3–6 hours (Fig. 1). This rebound may result from drug recirculation from plasma protein binding sites. Recirculation from peripheral compartments is less likely to occur because of the low vancomycin volume of distribution, indicating that the drug remains mainly in plasma. This rebound may be clinically significant, and it must be taken into account when determining vancomycin trough levels. Subsequently, it is recommended that determination of vancomycin trough levels in patients undergoing chronic haemodialysis should be performed before the haemodialysis session (Table 2).

Bottom Line: Furthermore, vancomycin easily diffuses through dialysis membranes.The aim of the present review is to establish guidelines for handling this drug in such patients.We indicate how and when plasma concentrations of vancomycin should be determined in dialysis patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Pitie-Salpetriere Hospital, Paris, France. vincent.launay-vacher@psl.ap-hop-paris.fr

ABSTRACT
Following intravenous administration, vancomycin is poorly metabolized and is mainly excreted unchanged in urine. Total body clearance is thus dependent on the kidney, and is correlated with glomerular filtration rate and creatinine clearance. Accumulation of vancomycin in patients with renal insufficiency may therefore occur, and this may lead to toxic side effects if dosage is not modified according to the degree of renal failure. Furthermore, vancomycin easily diffuses through dialysis membranes. The aim of the present review is to establish guidelines for handling this drug in such patients. We indicate how and when plasma concentrations of vancomycin should be determined in dialysis patients.

Show MeSH
Related in: MedlinePlus