EFFECTS OF DIALYSIS MEMBRANE ON INTRADIALYTIC VANCOMYCIN ADMINISTRATION

Study Objective. To quantify the influence of hemodialyzers on vancomy cin removal when the drug was infused during hemodialysis. Design. Pro spective, controlled, crossover study with three arms. Setting. A univ ersity-affiliated medical center. Patients. Eight subjects receiving o utpatient hemodialysis. Interventions. The three treatment arms were v ancomycin 1000 mg infused after dialysis was completed (control), and the same dosages infused during the last hour of hemodialysis with a c ellulose triacetate (CT) and a cellulose acetate (CA) hemodialyzer. Me asurements and Main Results. The areas under the curve from time zero to 44 hours (AUC(0-44 hrs)) for the three study arms were significantl y different (p<0.05), with the mean vancomycin AUC(0-44 hrs) being sig nificantly lower when administered during CT and CA dialysis (73.7% an d 87.2% of control; p<0.05 vs control). The mean vancomycin peak conce ntration achieved during CT dialysis was significantly lower than for the CA and control arms (20.5, 23.9, 27.0 mg/L, respectively). Forty-f our-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.