Experience with Vancomycin in Patients Receiving Slow Low-Efficiency Dialysis

Abstract

Background Slow low-efficiency dialysis (SLED) is an emerging dialytic strategy for managing acute renal failure. There is no published data describing how SLED effects the pharmacokinetics of vancomycin. Methods A prospective pharmacokinetic evaluation of vancomycin was performed in critically ill medical and surgical patients with acute renal failure who required IV vancomycin and concurrent SLED therapy. Patients received vancomycin 15 mg/kg by actual body weight. Serum drug concentrations were evaluated at 6, 12, and 24 hours postinfusion. Patient-specific vancomycin pharmacokinetic parameters were determined from serum concentrations to calculate a maintenance dosage regimen. Results Mean ± SD half-life, volume of distribution, and systemic clearance, were 43.1 hours ± 21.6 hours, 0.84 L/kg ± 0.17 L/kg, and 24.3 mL/min ± 8.39 mL/min, respectively. Vancomycin dosing intervals ranged from 24 to 72 hours. Conclusion The elimination half-life of vancomycin was variable and prolonged in patients receiving SLED therapy. An initial vancomycin dose of 15 mg/kg is recommended for patients receiving SLED. Given the variability of the vancomycin half-life during SLED, a vancomycin serum concentration should be obtained 24 hours following the initial dose.