Dosing of Aminoglycosides in Chronic Kidney Disease and End-Stage Renal Disease Patients Treated with Intermittent Hemodialysis

Kidney & Blood Pressure Research

Barbora Agatha Halouzková¹  Ondřej Slanař¹  Jan Miroslav Hartinger¹  Vladimír Tesař²  Vojtěch Krátký² 

[1] Department of Clinical Pharmacology and Pharmacy, Institute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia;Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia;

关键词: gentamicin;    amikacin;    tobramycin;    renal insufficiency;    dialysis membranes;    pulse dosing;    conventional dosing;    renal dialysis;   

DOI  :  10.1159/000523892

来源: DOAJ

【 摘 要 】

Background: The dosing of aminoglycosides (AGs) in patients with kidney disease is challenging due to their markedly prolonged half-life, which renders pulse dosing schedules unsuitable. We performed a review of the literature that describes the pharmacokinetics of, and dosing recommendations for, AG for patients with abnormal renal functions and various renal replacement therapy modalities, focusing on patients treated with intermittent hemodialysis (iHD). Summary: During one iHD session, dialysis removes a remarkable amount of the drug regardless of the dialyzer type. In patients with severely reduced kidney functions, the distribution phase is prolonged, which needs to be taken into account when drawing samples shortly after drug administration or following an iHD session. Key Messages: The doses recommended for the pulse dosing of patients without kidney disease leads to unacceptably high overall systemic exposure for patients with severely reduced kidney functions even with dosing intervals extended up to 48 h. Therefore, lower doses accompanied by extended dosing intervals must be applied for this patient group. The clinical evidence and current recommendations support the dosing of AG following, rather than before, HD sessions. In patients with end-stage kidney disease, the samples for TDM of AGs should not be drawn earlier than 2 h after end of the infusion and 4 h after the end of iHD session to allow full (re)distribution of the drug.

【 授权许可】

Unknown