• Shin-Yi Lin, Li-Jiuan Shen, Vin-Cent Wu, Wen-Je Ko, Chien-Chih Wu, and Fe-Lin Lin Wu.
• Department of Pharmacy, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, No. 33, Linsen S. Rd., Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, No. 33, Linsen South Road, Taipei, Taiwan.
• J Formos Med Assoc. 2021 Jan 1; 120 (1 Pt 3): 737-743.

Background/PurposeThe pharmacokinetics of vancomycin in patients who undergo sustained low efficiency daily diafiltration (SLEDD-f) is not clear. This study aimed to determine the appropriate vancomycin dosage regimen for patients receiving SLEDD-f.MethodsThis prospectively observational study enrolled critically ill patients older than 18 years old that used SLEDD-f as renal replacement therapy and received vancomycin treatment. An 8-h SLEDD-f was performed with FX-60 (high-flux helixone membrane, 1.4 m2). Serial blood samples were collected before, during, and after SLEDD-f to analyse vancomycin serum concentrations. Effluent fluid samples (a mixture of dialysate and ultrafiltrate) were also collected to determine the amount of vancomycin removal.ResultsSeventeen patients were enrolled, and 10 completed the study. The amount of vancomycin removal was 447.4 ± 88.8 mg (about 78.4 ± 18.4% of the dose administered before SLEDD-f). The vancomycin concentration was reduced by 57.5 ± 14.9% during SLEDD-f, and this reduction was followed by a rebound with duration of one to three hours. The elimination half-life of vancomycin decreased from 64.1 ± 35.7 h before SLEDD-f to 7.0 ± 3.0 h during SLEDD-f.ConclusionSignificant amount of vancomycin removed during SLEDD-f. Despite the existence of post-dialysis rebound, a sufficient supplemental dose is necessary to maintain therapeutic range.Copyright © 2020 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.

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