Differences in drug removal between standard high-flux and medium cut-off dialyzers in a case of severe vancomycin toxicity

Author:

Aberger Simon12,Kolland Michael1,Eller Kathrin1ORCID,Rosenkranz Alexander R1,Kirsch Alexander H1ORCID

Affiliation:

1. Division of Nephrology, Department of Internal Medicine, Medical University of Graz , Graz , Austria

2. Department of Internal Medicine I, Paracelsus Medical University , Salzburg , Austria

Abstract

ABSTRACT Vancomycin is a widely used glycopeptide antibiotic with the need for therapeutic drug monitoring to avoid renal toxicity. We report a case of severe vancomycin-associated anuric acute kidney injury managed with successful drug-removal by hemodialysis (HD) using different types of dialyzers. Medium cut-off (MCO) and high-flux dialyzers were effective in drug removal. Higher vancomycin elimination rate and lower plasma half-life were achieved with MCO dialyzer despite low-flow vascular access and intolerance to ultrafiltration. MCO dialyzers may be reasonable for drug removal in patients with intolerance of ultrafiltration, low-flow vascular access or impracticality of hemodiafiltration. Future studies should explore the use of MCO dialyzers in comparison with high-flux HD and hemodiafiltration in both the acute and chronic setting.

Publisher

Oxford University Press (OUP)

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