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Kidney Week

Abstract: FR-PO225

Determining Vancomycin Dosing Recommendations in Patients Receiving Home Hemodialysis (HHD) Using Monte Carlo Simulations

Session Information

  • Pharmacology
    November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pharmacology (PharmacoKinetics‚ -Dynamics‚ -Genomics)

  • 1900 Pharmacology (PharmacoKinetics‚ -Dynamics‚ -Genomics)

Authors

  • Lewis, Susan J., University of Findlay College of Pharmacy, Findlay, Ohio, United States
  • Jang, Soo min, Loma Linda University, Loma Linda, California, United States
  • Mueller, Bruce A., University of Michigan College of Pharmacy, Ann Arbor, Michigan, United States
Background

HHD is resurging due to clinical benefits and technology advances. Vancomycin is commonly prescribed in end stage kidney disease patients receiving conventional dialysis. HHD utilizes more frequent and/or longer dialysis sessions than standard thrice-weekly hemodialysis and optimal vancomycin doses are likely different for those with HHD. This study was designed to determine optimal vancomycin dosing strategies incorporating therapeutic drug monitoring (TDM) for patients receiving common HHD settings.

Methods

Pharmacokinetic models were developed using internal outpatient dialysis patient demographic data and published pharmacokinetic parameters to predict vancomycin disposition in 5,000 virtual patients receiving HHD using Monte Carlo simulations. Many vancomycin doses infused post-dialysis were tested to evaluate the probability of target attainment (PTA) in 10 different HHD regimens (Table). The pharmacodynamic target was a 24-hour area under the curve/minimum inhibitor concentration (AUC24h:MIC)≥400 mg*h (assuming the MIC of 1 mg/L) since the upper AUC24h threshold linked with nephrotoxicity is usually of less concern in this population compared to an AKI population. The smallest vancomycin doses attaining PTA≥90% during 1-week of therapy were considered optimal initial dosing. Therapeutic drug monitoring (TDM) using a single pre-dialysis vancomycin concentration was developed to individualize subsequent vancomycin doses.

Results

Vancomycin doses and TDM schedules that achieved acceptable PTA rates appear in the figure.

Conclusion

Optimal vancomycin dosing recommendations for HHD patients differ from those for conventional thrice-weekly hemodialysis. These vancomycin dosing recommendations warrant clinical validation.

Optimal initial vancomycin doses and TDM strategy in ten HHD settings to attain AUC24h ≥400 mg*h

Funding

  • Commercial Support