Summary
Vancomycin is usually given only once a week to haemodialysis (HD) patients. If highly permeable dialysis membranes are used, however, high clearance values have been reported, so the aim of the study was to determine whether high clearance of vancomycin resulted in sufficient drug elimination to induce subtherapeutic plasma levels after one week. In 18 chronic HD patients, treated with polysulfone dialyzers (1.2 m2), the pharmacokinetics of vancomycin were studied after administration of 1 g. Concentrations were determined by fluorescence polarisation immunoassay.
At a blood flow of 219 ml·min−1, HD clearance of vancomycin was 62.3 ml·min−1. Immediately after dialysis plasma concentrations were 38% lower than predialysis levels. However, marked rebound in the vancomycin level was observed 5 h later, resulting in plasma levels only 16% lower than prior to dialysis. 3 HD treatments in 1 week removed about one third of the initial dose. After one week 15 of 18 patients still had a therapeutic plasma level (>5 μg·ml−1).
In conclusion, polysulfone membranes show high clearance of vancomycin. However, transfer of drug from blood to dialysate appears to be faster than from tissues to blood. Because of a marked rebound in plasma level after treatment, therapeutic drug concentrations will still be present in most patients after one week.
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References
Masur H, Francioli P, Ruddy M, Murray HW (1983) Vancomycin serum levels and toxicity in chronic hemodialysis patients with staphylococcus aureus bacteremia. Clin Nephrol 20: 85–88
Eykyn S, Phillips I, Evans J (1970) Vancomycin for staphylococcal shunt side infections in patients on regular haemodialysis. Br Med J 3: 80–82
Appel GB, Given DB, Levine LR, Cooper GL (1986) Vancomycin and the kidney. Am J Kidney Dis 8: 75–80
Bierman MH, Needham-Walker CA, Hammeke M, Egan JD (1980) Vancomycin therapy for serious staphylococcal infections in chronic hemodialysis patients. J Dialysis 4: 179–184
Edell LS, Westby GR, Gould SR (1988) An improved method of vancomycin administration to dialysis patients. Clin Nephrol 1988; 29: 86–87
Lindholm DD, Murray JS (1966) Persistence of vancomycin in the blood during renal failure and its treatment by hemodialysis. N Engl J Med 274: 1047–1051
Matzke GR, Zhanel GG, Guay DRP (1986) Clinical pharmacokinetics of vancomycin. Clin Pharmacokinet 11: 257–282
Lanese DM, Alfrey PS, Molitoris BA (1989) Markedly increased clearance of vancomycin during hemodialysis using polysulfone dialyzers. Kidney Int 35: 1409–1412
de Bock V, Verbeelen D, Maes V, Sennesael J (1989) Pharmacokinetics of vancomycin in patients undergoing hemodialysis and hemofiltration. Nephrol Dial Transplant 4: 635–639
Keller F (1988) Vancomycin administration to hemodialysis patients. Clin Nephrol 30: 173
Torras J, Cao C, Rivas MC, Cano M, Fernandez E, Montoliu J (1991) Pharmacokinetics of vancomycin in patients undergoing hemodialysis with polyacrylonitrile. Clin Nephrol 36: 35–41
Bastani B, Spyker DA, Minocha A, Cummings R, Westervelt FB (1988) In vitro comparison of three different hemodialysis membranes for vancomycin clearance: Cuprophan, cellulose acetate, and polyacrylonitrile. Dial Transplant 17: 527–543
van Stone JC (1988) Hemodialysis apparatus. In: Daugirdas JT and Ing TS, eds. Handbook of dialysis. Little Brown and Co, Boston, pp 21–39
Schwenzer KS, Chao-Huei JW, Anhalt JP (1983) Automated fluorescence polarisation immunoassay for monitoring vancomycin. Ther Drug Monit 5: 341–345
Geraci JE, Hermans PE. Vancomycin (1983) Mayo Clin Proc 58: 88–91
Jindal K, Manuel A, Goldstein M (1987) Percent reduction of urea during hemodialysis (PRU), a simple and acurate method to estimate KT/V. ASAIO Trans 33: 286–288
Lee CC, Marbury TC. Drug therapy in patients undergoing haemodialysis (1984) Clinical pharmacokinetic considerations. Clin Pharmacokinet 9: 42–66
von Hattingberg HM, Brockmeier D, Kreuter G (1977) A rotating iterative procedure (RIP) for estimating hybrid constants in multi-compartment analysis on desk computers. Eur J Clin Pharmacol 11: 381–388
Vozeh S, Schidlin O, Taeschner W (1988) Pharmacokinetic drug data. Clin Pharmacokinet 13: 254–282
Bennett WM, Aronoff GR, Morrison G, Golper TA, Pulliam J, Wolfson M, Singer I (1983) Drug prescribing in renal failure: Dosing guidelines for adults. Am J Kidney Dis 3: 155–193
Babb AL, Johansen PJ, Strand MJ, Tenckhoff H, Scribner BH (1973) Bi-directional permeability to human peritoneum to middle molecules. Proc Eur Dial Transplant Assoc 10: 247–257
Krogstad DJ, Moellering RC, Greenblatt DJ (1980) Single-dose kinetics of intravenous vancomycin. J Clin Pharmacol 20: 197–201
Böhler J, Reetze P, Keller E, Kramer A, Schollmeyer PJ (1990) Elimination of Vancomycin with highly permeable dialysis membranes. Nephrol Dial Transplant 5: 697
Röckel A, Abdelhamid S, Fliegel P, Walb D. Elimination of low molecular weight proteins with high flux membranes (1985) Contrib Nephrol 46: 69–74
Reetze-Bonorden P, Böhler J, Kohler C, Schollmeyer P, Keller E (1991) Elimination of Vancomycin in patients on continuous arteriovenous hemodialysis. Contrib Nephrol 93: 135–139
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Böhler, J., Reetze-Bonorden, P., Keller, E. et al. Rebound of plasma vancomycin levels after haemodialysis with highly permeable membranes. Eur J Clin Pharmacol 42, 635–639 (1992). https://doi.org/10.1007/BF00265928
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DOI: https://doi.org/10.1007/BF00265928