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FACTORS AFFECTING THE POST-DIALYSIS LEVELS OF VANCOMYCIN AND GENTAMICIN IN HAEMODIALYSIS PATIENTSINTRODUCTION: Infections are not an uncommon occurrence in patients with kidney disease. Those undergoing dialysis are also prone to dialysis access related infections. Empirical antibiotic therapy in our unit is Vancomycin and Gentamicin. These drugs have a narrow therapeutic index and need to be administered based on serum levels so as to avoid toxicity and to ensure efficacy. Delays in obtaining the drug levels can lead to missed doses or inappropriately administered doses, with potential adverse effects on the patient. We investigated whether there were any parameters which could help predict what the percentage reduction of the pre-dialysis drug levels would be following a dialysis session. METHODS: Inpatients on antibiotic therapy for various indications were included in this study. All the patients were on haemodiafiltration (HDF) using Fresenius 5008 machines and FX60 high-flux dialysers. Data on weight, dialysis access type, blood pump speed, duration of dialysis, litres processed per session, ultrafiltration volume, time on dialysis and Vancomycin and Gentamicin levels (checked before and at the end of HDF sessions) were collected and analysed.RESULTS: 88 samples were collected from 21 patients, 62% of whom were male. The mean age was 70.2 years (range 37-91). There was no correlation between blood pump speed, duration of dialysis, litres processed per session, ultrafiltration volume and time on dialysis with the percentage reduction of the pre-dialysis drug level following dialysis. When the litres processed per session was adjusted for body weight pre-dialysis, we found a close correlation (R2 = 0.23). This was not the case with ultrafiltration volume/kg body weight (R2 = 0.003). 36748058279Percentage reduction of pre-dialysis antibiotic level (y) against litres of blood processed per kilogram body weight (x)0Percentage reduction of pre-dialysis antibiotic level (y) against litres of blood processed per kilogram body weight (x)CONCLUSION: The best correlation with the percentage reduction in drug level following dialysis was the litres processed adjusted for pre-dialysis body weight. All our patients were using high-flux dialysers and were on HDF, so it is not clear whether this would apply to patients using either low-flux dialysers, or patients on haemodialysis rather than HDF. If it is possible to come up with a ‘nomogram’, based on a few of these parameters (litres processed, weight, dialyser, HD vs HDF) to guide antibiotic dosing, it would be of great benefit, especially in the management of patients on these antibiotics in the outpatient setting. ................
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