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Baud FJ, Jullien V, Desnos-Ollivier M, Lamhaut L, Lortholary O. Caspofungin sequestration in a polyacrylonitrile-derived filter: Increasing the dose does not mitigate sequestration. Int J Antimicrob Agents 2023; 62:107007. [PMID: 37839719 DOI: 10.1016/j.ijantimicag.2023.107007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 09/10/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES Critically ill patients frequently require continuous renal replacement therapy. Echinocandins are recommended as first-line treatment of candidemia. Preliminary results suggested echinocandin sequestration in a polyacrylonitrile filter. The present study aimed to determine whether increasing the dose might balance sequestration. METHODS An STX filter (Baxter-Gambro) was used. A liquid chromatography-mass spectrometry method was used for dosage of caspofungin. In vitro drug disposition was evaluated by NeckEpur (Neckepur, Versailles, France) technology using a crystalloid medium instead of diluted/reconstituted blood, focusing on the disposition of the unbound fraction of drugs. Two concentrations were assessed. RESULTS At the low dose, the mean measured initial concentration in the central compartment (CC) was 5.1 ± 0.6 mg/L. One hundred percent of the initial amount was eliminated from the CC within the 6-h session. The mean total clearance from the CC was 9.6 ± 2.5 L/h. The mean percentages of elimination resulting from sequestration and diafiltration were 96.0 ± 5.0 and 4.0 ± 5.2%, respectively. At high dose, the mean measured initial concentration in the CC was 13.1 mg/L. One hundred percent of the initial amount was eliminated from the CC within the 6-h session. The mean total clearance from the CC was 9.5 L/h. The mean percentages of elimination resulting from sequestration and filtration were 88.5% and 11.5%, respectively. CONCLUSION Increasing the dose does not mitigate caspofungin sequestration in the STX filter. The results raise caution about the simultaneous use of caspofungin and polyacrylonitrile-derived filters. Intermittent modes of renal replacement therapy might be considered. For sensitive species, fluconazole might be an alternative.
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Affiliation(s)
- Frédéric J Baud
- Département d'Anesthésie-Réanimation Adulte-SAMU de Paris, Hôpital Necker; Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France.
| | - Vincent Jullien
- Université Sorbonne Paris Nord, IAME, INSERM, Paris, France; UF de Pharmacologie, Hôpital Jean Verdier, APHP, Bondy, France
| | | | - Lionel Lamhaut
- Département d'Anesthésie-Réanimation Adulte-SAMU de Paris, Hôpital Necker; Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France
| | - Olivier Lortholary
- Necker Pasteur Centre for Infectious Diseases and Tropical Medicine, IHU Imagine, Necker Enfants Malades, University Hospital, Paris, France; Institut Pasteur, Université Paris Cité, Paris, France
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Baud FJ, Wasram Jetha-Jamal T, Vicca S, Raphalen JH, Lamhaut L. Disposition of gentamicin and amikacin in extracorporeal membrane oxygenation using a heparin-coated filter: An in vitro assessment. Int J Artif Organs 2022; 45:588-592. [PMID: 35531752 DOI: 10.1177/03913988221097432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Disposition of gentamicin and amikacin during extracorporeal membrane oxygenation has not been addressed in in vitro models. The HLS Advanced 7.0® circuit with the Cardio Help® monitor, Getinge, was used. The 5-L central compartment (CC) was loaded with gentamicin and amikacin at a targeted concentration of 40 and 80 mg/L in the same bag prior connection to the circuit. Samples were collected in the CC, the inlet and outlet ports from 15 min to 6 h post-connection. Pharmacokinetic analyses were performed using the NeckEpur® method. Analysis of results of gentamicin and amikacin showed in the filter-pump block (i) the extremely low value of the extraction coefficients, (ii) similar values of the areas under the curve (AUCs) at the inlet and outlet ports, (iii) using the Wilcoxon matched pairs signed rank test no significant differences of the inlet-outlet concentrations in the filter-pump. In the whole system (i) the amounts recovered in the CC at the end of the 6-h session were not significantly different from the initial values, (ii) the extremely low values of the total clearance of gentamicin and amikacin from the CC in comparison with the measured simulated blood flowrate, (iii) the lack of significant time-concentration interactions in the CC and the inlet and outlet ports. These findings allow concluding no detectable adsorption of gentamicin and amikacin occurred in the HLS Advanced 7.0 circuit.
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Affiliation(s)
- Frédéric J Baud
- Département d'Anesthésie et de Réanimation, Adult Intensive Care Unit, Necker Hospital, Paris, France.,University de Paris City, Paris, France.,EA7323 Université de Paris City, Paris, France
| | | | | | - Jean-Herlé Raphalen
- Département d'Anesthésie et de Réanimation, Adult Intensive Care Unit, Necker Hospital, Paris, France
| | - Lionel Lamhaut
- Département d'Anesthésie et de Réanimation, Adult Intensive Care Unit, Necker Hospital, Paris, France.,University de Paris City, Paris, France
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Baud FJ, Seif V, Houzé P, Raphalen JH, Pilmis B, Carli P, Lamhaut L. Elimination of three doses of gentamicin over three consecutive days using a polyacrylonitrile-derived filter: An in vitro assessment. Int J Artif Organs 2021; 44:641-650. [PMID: 34348515 DOI: 10.1177/03913988211032236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Adsorption of gentamicin in a polyacrylonitrile filter was previously evidenced in a session lasting 6 h using the NeckEpur model. We extended the study over three consecutive days to mimic the 72-h life span of a filter. METHODS Prismaflex® monitor and ST150® filter were used in the continuous diafiltration (CDF) mode at a 2.5 L/h flowrate. The daily session started with a 6-h session of CDF. Thereafter, the 5-L central compartment was changed using a bag free of gentamicin to assess gentamicin release over the following 18 h. Experiments were repeated on Day 2 and stopped at the end of the 6-h session of CDF on Day 3. The experiment was performed in duplicate. RESULTS At a 2.5 L/h diafiltration flowrate, the mean daily clearances of gentamicin were 5.5, 4.0, and 3.3 L/h, respectively. The mean diafiltration and adsorption ratios in the daily elimination of gentamicin were 32/68%, 58/42%, and 88/12%, respectively. During days 1 and 2, the mean amount of gentamicin released from the ST150® filter were 14 and 34 mg, respectively. CONCLUSION The pharmacokinetics of gentamicin over 3 days is strongly altered by adsorption in the same filter with a progressive decrease of elimination by adsorption, suggesting saturation of the filter. One limitation of our study results from the mode of administration using a bolus dose instead of an infusion over 30 min. Adsorption adds a clearance to those of diafiltration. The time-dependency of gentamicin clearance precludes using a constant dosage regimen over the filter's life span.
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Affiliation(s)
- Frédéric J Baud
- Adult Intensive Care Unit, Department of Anesthesiology - SAMU de Paris, Assistance Publique - Hôpitaux de Paris, University Hospital Necker, Paris, France.,EA7323 Evaluation of Therapeutics and Pharmacology in Perinatality and Pediatrics - Hôpitaux Universitaires Cochin - Broca - Hôtel Dieu, Site Tarnier, Université Paris Descartes, Paris, France.,Université de Paris - Paris Diderot, Paris, France
| | - Vanessa Seif
- Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Pascal Houzé
- CNRS UMR 8258 - U1022, Faculty of Pharmacy, Unité de Technologies Chimiques et Biologiques pour la Santé, Paris, France
| | - Jean-Herlé Raphalen
- Adult Intensive Care Unit, Department of Anesthesiology - SAMU de Paris, Assistance Publique - Hôpitaux de Paris, University Hospital Necker, Paris, France
| | - Benoît Pilmis
- Molecular Mycology Unit, CNRS UMR 2000, Pasteur Institute, Paris, France
| | - Pierre Carli
- Adult Intensive Care Unit, Department of Anesthesiology - SAMU de Paris, Assistance Publique - Hôpitaux de Paris, University Hospital Necker, Paris, France.,Université de Paris - Paris Descartes, Paris, France
| | - Lionel Lamhaut
- Adult Intensive Care Unit, Department of Anesthesiology - SAMU de Paris, Assistance Publique - Hôpitaux de Paris, University Hospital Necker, Paris, France.,Université de Paris - Paris Descartes, Paris, France
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Baud FJ, Jullien V, Abarou T, Pilmis B, Raphalen JH, Houzé P, Carli P, Lamhaut L. Elimination of fluconazole during continuous renal replacement therapy. An in vitro assessment. Int J Artif Organs 2020; 44:453-464. [DOI: 10.1177/0391398820976144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Continuous renal replacement therapy (CRRT) efficiently eliminates fluconazole. However, the routes of elimination were not clarified. Adsorption of fluconazole by filters is a pending question. We studied the elimination of fluconazole in a model mimicking a session of CRRT in humans using the NeckEpur® model. Two filters were studied. Methods: The AV1000®-polysulfone filter with the Multifiltrate Pro. Fresenius and the ST150®-polyacrylonitrile filter with the Prismaflex. Baxter-Gambro were studied. Continuous filtration used a flowrate of 2.5 L/h in post-dilution only. Session were made in duplicate. Routes of elimination were assessed using the NeckEpur® model. Results: The mean measured initial fluconazole concentration (mean ± SD) for the four sessions in the central compartment (CC) was 14.9 ± 0.2 mg/L. The amount eliminated from the CC at the end of 6 h-session at a 2.5 L/h filtration flowrate for the AV1000®-polysulfone and the ST150®-polyacrylonitrile filters were 90%–93% and 96%–94%, respectively; the clearances from the central compartment (CC) were 2.5–2.6 and 2.4–2.3 L/h, respectively. The means of the instantaneous sieving coefficient were 0.94%–0.91% and 0.99%–0.91%, respectively. The percentages of the amount eliminated from the CC by filtration/adsorption were 100/0%–95/5% and 100/0%–100/0%, respectively. Conclusion: Neither the ST150®-polyacrylonitrile nor the AV1000®-polysulfone filters result in any significant adsorption of fluconazole.
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Affiliation(s)
- Frédéric J Baud
- Department of Anesthesiology and Intensive Care Medicine, Adult Intensive Care Unit, Necker Hospital, Paris, France
- EA7323 Evaluation of Therapeutics and Pharmacology in Perinatality and Pediatrics, Hôpitaux Universitaires Cochin—Broca—Hôtel Dieu, Site Tarnier, Université Paris Descartes, Paris, France
- University Paris Diderot, Paris, France
| | - Vincent Jullien
- Assistance Publique—Hôpitaux de Paris, Groupe Hospitalier Paris Seine-Saint-Denis, Bobigny, France
- Molecular Mycology Unit-CNRS UMR 2000, Pasteur Institute, Paris, France
| | - Tarik Abarou
- Laboratoire de Chimie Analytique, Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Benoît Pilmis
- Equipe Mobile de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
- Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Paris, France
- Institut Micalis, UMR 1319, Université Paris-Saclay, INRAe, AgroParisTech, Chatenay-Malabry, France
| | - Jean-Herlé Raphalen
- Department of Anesthesiology and Intensive Care Medicine, SAMU de Paris, Adult Intensive Care Unit, Necker Hospital, Paris, France
| | - Pascal Houzé
- Laboratoire de Biochimie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique—Hôpitaux de Paris, Paris, France
- Unité de Technologies Chimiques et Biologiques Pour la Santé, CNRS UMR8258 – U1022, Faculté de Pharmacie Paris Descartes, Paris, France
- Université Paris Descartes, Paris, France
| | - Pierre Carli
- Department of Anesthesiology and Intensive Care Medicine, SAMU de Paris, Adult Intensive Care Unit, Necker Hospital, Paris, France
- Université Paris Descartes, Paris, France
| | - Lionel Lamhaut
- Department of Anesthesiology and Intensive Care Medicine, SAMU de Paris, Adult Intensive Care Unit, Necker Hospital, Paris, France
- Université Paris Descartes, Paris, France
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Baud FJ, Houzé P, Raphalen JH, Winchenne A, Philippe P, Carli P, Lamhaut L. Diafiltration flowrate is a determinant of the extent of adsorption of amikacin in renal replacement therapy using the ST150®-AN69 filter: An in vitro study. Int J Artif Organs 2020; 43:758-766. [DOI: 10.1177/0391398820911928] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: In continuous renal replacement therapy, conduction and convection are controlled allowing prescribing dosage regimen improving survival. In contrast, adsorption is an uncontrolled property altering drug disposition. Whether adsorption depends on flowrates is unknown. We hypothesized an in vitro model may provide information in conditions mimicking continuous renal replacement therapy in humans. Methods: ST150®-AN69 filter and Prismaflex dialyzer, Baxter-Gambro were used. Simulated blood flowrate was set at 200 mL/min. The flowrates in the filtration (continuous filtration), dialysis (continuous dialysis), and diafiltration (continuous diafiltration) were 1500, 2500, and 4000 mL/h, respectively. Routes of elimination were assessed using NeckEpur® analysis. Results: The percentages of the total amount eliminated by continuous filtration, continuous dialysis, and continuous diafiltration were 82%, 86%, and 94%, respectively. Elimination by effluents and adsorption accounted for 42% ± 7% and 58% ± 5%, 57% ± 7% and 43% ± 6%, and 84% ± 6% and 16% ± 6% of amikacin elimination, respectively. There was a linear regression between flowrates and amikacin clearance: Y = 0.6 X ± 1.7 (R2 = 0.9782). Conversely, there was a linear inverse correlation between the magnitude of amikacin adsorption and flowrate: Y = –16.9 X ± 84.1 (R2 = 0.9976). Conclusion: Low flowrates resulted in predominant elimination by adsorption, accounting for 58% of the elimination of amikacin from the central compartment in the continuous filtration mode at 1500 mL/h of flowrate. Thereafter, the greater the flowrate, the lower the adsorption of amikacin in a linear manner. Flowrate is a major determinant of adsorption of amikacin. There was an about 17% decrease in the rate of adsorption per increase in the flowrate of 1 L/min.
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Affiliation(s)
- Frédéric Joseph Baud
- Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France
- Université de Paris, Paris, France
- EA7323, Université de Paris, Paris, France
| | - Pascal Houzé
- Laboratoire de Biochimie, Necker Hospital, Paris, France
- UMR8258 – U1022, Paris, France
| | - Jean-Herlé Raphalen
- Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France
| | - Anaïs Winchenne
- Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France
| | - Pascal Philippe
- Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France
| | - Pierre Carli
- Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France
- Université de Paris, Paris, France
| | - Lionel Lamhaut
- Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France
- Université de Paris, Paris, France
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Osimertinib in a patient with non-small cell lung cancer and renal failure undergoing hemodialysis: a case report. Invest New Drugs 2019; 38:1192-1195. [DOI: 10.1007/s10637-019-00851-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 08/28/2019] [Indexed: 12/18/2022]
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Urata M, Narita Y, Fukunaga M, Kadowaki D, Hirata S. Simple Formula for Predicting Drug Removal Rates During Hemodialysis. Ther Apher Dial 2018; 22:485-493. [PMID: 29987905 DOI: 10.1111/1744-9987.12675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/16/2017] [Accepted: 01/22/2018] [Indexed: 11/28/2022]
Abstract
The present study sought to derive a simple formula for predicting the drug removal rates during hemodialysis. We examined the relationship between drug removal rates during hemodialysis and the molecular weights or pharmacokinetic parameters of injectable drugs (N = 90) obtained from pharmaceutical interview forms in Japan. Stepwise multiple regression analysis with the removal rate by hemodialysis as the objective variable adjusted for molecular weight or pharmacokinetic parameters as explanatory variables, showed that the logarithm of molecular weight (B = -18.87), the protein binding rate (B = -0.40), and the fraction of the unchanged drug excreted into the urine/volume of distribution (B = 0.05) were significantly and independently associated with drug removal rate by hemodialysis (α = 90.78, adjusted R2 = 0.64, P = 2.2e-16 ). Our data demonstrated that molecular weight, protein binding rate, and volume of distribution were important factors affecting drug removal during hemodialysis, and that our simple regression equation could be used to predict the drug removal rate during hemodialysis.
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Affiliation(s)
- Motoki Urata
- Center for Clinical Pharmaceutical Sciences, Division of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuki Narita
- Center for Clinical Pharmaceutical Sciences, Division of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masaki Fukunaga
- Center for Clinical Pharmaceutical Sciences, Division of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Daisuke Kadowaki
- Laboratory of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Sojo University, Kumamoto, Japan
| | - Sumio Hirata
- Center for Clinical Pharmaceutical Sciences, Division of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
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Ghannoum M, Wiegand TJ, Liu KD, Calello DP, Godin M, Lavergne V, Gosselin S, Nolin TD, Hoffman RS. Extracorporeal treatment for theophylline poisoning: systematic review and recommendations from the EXTRIP workgroup. Clin Toxicol (Phila) 2015; 53:215-29. [PMID: 25715736 DOI: 10.3109/15563650.2015.1014907] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The Extracorporeal Treatments in Poisoning workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments (ECTRs) in poisoning. Here, the workgroup presents its systematic review and recommendations for theophylline. METHODS After a systematic review of the literature, a subgroup reviewed articles, extracted data, summarized findings, and proposed structured voting statements following a pre-determined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and the RAND/UCLA Appropriateness Method was used to quantify disagreement. Anonymous votes were compiled, returned, and discussed. A second vote determined the final recommendations. RESULTS 141 articles were included: 6 in vitro studies, 4 animal studies, 101 case reports/case series, 7 descriptive cohorts, 4 observational studies, and 19 pharmacokinetic studies, yielding a low-to-very-low quality of evidence for all recommendations. Data on 143 patients were reviewed, including 10 deaths. The workgroup concluded that theophylline is dialyzable (level of evidence = A) and made the following recommendations: ECTR is recommended in severe theophylline poisoning (1C). Specific recommendations for ECTR include a theophylline concentration [theophylline] > 100 mg/L (555 μmol/L) in acute exposure (1C), the presence of seizures (1D), life-threatening dysrhythmias (1D) or shock (1D), a rising [theophylline] despite optimal therapy (1D), and clinical deterioration despite optimal care (1D). In chronic poisoning, ECTR is suggested if [theophylline] > 60 mg/L (333 μmol/L) (2D) or if the [theophylline] > 50 mg/L (278 μmol/L) and the patient is either less than 6 months of age or older than 60 years of age (2D). ECTR is also suggested if gastrointestinal decontamination cannot be administered (2D). ECTR should be continued until clinical improvement is apparent or the [theophylline] is < 15 mg/L (83 μmol/L) (1D). Following the cessation of ECTR, patients should be closely monitored. Intermittent hemodialysis is the preferred method of ECTR (1C). If intermittent hemodialysis is unavailable, hemoperfusion (1C) or continuous renal replacement therapies may be considered (3D). Exchange transfusion is an adequate alternative to hemodialysis in neonates (2D). Multi-dose activated charcoal should be continued during ECTR (1D). CONCLUSION Theophylline poisoning is amenable to ECTRs. The workgroup recommended extracorporeal removal in the case of severe theophylline poisoning.
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Affiliation(s)
- Marc Ghannoum
- Department of Nephrology, Verdun Hospital, University of Montreal , Verdun , Canada
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Jang SM, Cardone KE, Nolin TD, Mason DL, Grabe DW. Determination of vancomycin and gentamicin clearance in an in vitro, closed loop dialysis system. BMC Nephrol 2014; 15:204. [PMID: 25526750 PMCID: PMC4289559 DOI: 10.1186/1471-2369-15-204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 11/13/2014] [Indexed: 11/11/2022] Open
Abstract
Background The purpose of this study was to evaluate the feasibility of utilizing an in-vitro, closed loop hemodialysis system as a method to assess drug clearance. Secondarily, this study tested the influence of variables (blood flow rate, dialysate flow rate, and type of filter) in the hemodialysis procedure on the clearance of vancomycin and gentamicin. Methods An in-vitro, closed loop hemodialysis system was constructed. The vancomycin (30 mg/L) and gentamicin (25 mg/L) were added to a simulated blood system (SBS). Four conditions (C1-C4) were tested by defining the filter (Polyflux 170H or F180) and the blood and dialysate flow rates (BFR and DFR). All hemodialysis sessions were 3 hours in length and each condition was completed in duplicate. Dialysate effluent was collected in a 50 gallon polyethylene drum. Samples were collected (in duplicate) from the SBS and the dialysate effluent at baseline and at the end of the hemodialysis session. Samples were analyzed for vancomycin and gentamicin with an ultrahigh performance liquid chromatography/tandem mass spectrometry method. Results A total of eight 3-hour hemodialysis sessions were conducted. For all tested conditions (C1-C4), vancomycin was undetectable in the SBS at the end of dialysis. However, total vancomycin recovery in the dialysis effluent was 85±18%, suggesting that up to 15% may have adsorbed to the dialysis filter or tubing. Gentamicin clearance from SBS was >98% in all tested conditions. Average gentamicin recovery in the dialysate effluent was 99±15%. Conclusion Both vancomycin and gentamicin were readily removed by high-flux hemodialysis under all conditions studied. No significant differences in drug clearance were observed between conditions used in this in vitro study. The clinical implications of changing these hemodialysis parameters are unknown.
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Affiliation(s)
| | | | | | | | - Darren W Grabe
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue, Albany 12208, NY, USA.
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Pinner NA, Canada RB, Broyles JE, Hudson JQ. Evaluation of Vancomycin and Gentamicin Dialysis Clearance Using In Vivo and In Vitro Systems. Ren Fail 2012; 34:703-7. [DOI: 10.3109/0886022x.2012.672153] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Prado M, Roa LM, Palma A, Milán JA. Improving hollow fiber dialyzer efficiency with a recirculating dialysate system. I: Theory and applicability. Ann Biomed Eng 2005; 33:642-55. [PMID: 15981864 DOI: 10.1007/s10439-005-4389-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The mathematical theory that underlies a novel non-regenerated recirculating dialysate system (RDS) for improving diffusive clearance in hemodialyzers is presented. The theory states the conditions that hemodialyzers must meet to be suitable in RDS optimization. We have verified the applicability of the RDS for several Cuprophan and polysulfone (PS) commercial dialyzers, showing that PS (synthetic) membranes achieve the highest increments of diffusive clearance. A numerical simulation analysis over more general conditions defined by the dimensionless groups of the system demonstrated that the highest diffusive clearance improvements are achieved in dialyzers operating with a low value of the diffusive mass-transfer area/blood flow rate ratio. This study has provided the base for the assessment of the performance of the RDS as compared to several high-efficiency systems, presented in Part II of this work [M. Prado, L. M. Roa, A. Palma, and J. A. Milan, Ann. Biomed. Eng. (2004) submitted].
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Affiliation(s)
- Manuel Prado
- Biomedical Engineering Group, University of Seville, University Hospital Virgen Macarena, Spain.
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