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Kidney Week

Abstract: TH-PO282

Antibiotics Dosing in Four-Hour Sustained Low-Efficiency Dialysis: A Retrospective Data Review

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Almarawi, Husien, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
  • Rahhal, Alaa, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
  • Aljundi, Amer, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
  • Kasem, Mohamed Mabrouk, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
  • Mahfouz, Ahmed Sobhy, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
  • Mahmoud, Khaled Mohamed, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
Background

Sustained Low-Efficiency Dialysis (SLED) is characterized by a slower blood flow rate than intermittent hemodialysis (IHD). SLED is usually done over 6-12 hours and a shorter duration of 4-hour might spare more time for procedures in critical care units (ICU). However, antibiotics dosing is not well established in 4-hour SLED, and clinicians might prescribe antibiotics using IHD dosing in view of the shorter duration.

Methods

In this single-center study, we assessed the dosing practices and clinical outcomes of antibiotics among recipients of 4-hour SLED. In-hospital mortality and recovery from sepsis were compared between those who received SLED dosing versus IHD dosing, using Cox regression and Kaplan-Meier curves. P-value <0.05 was set to represent statistical significance.

Results

A total of 107 patients who underwent 4-hour SLED and received at least one broad-spectrum antibiotic were identified between 1/06/2016 to 1/06/2020. Among them, 68% were male with a mean age of 68 ± 12 years. The majority of patients were from the Middle East (81%). Around 20% had positive urine cultures, 19% had positive blood cultures, and 10% had positive sputum cultures. The majority of 4-hour SLED recipients (84%) were prescribed antibiotics according to IHD dosing, while only 16% were prescribed SLED dosing regimens. The use of SLED-based recommended dosing in 4-hour SLED resulted in significantly higher sepsis recovery [76% vs. 42%, HR= 2.02, 95 CI (1.07-3.82), p=0.030]. Interestingly, the in-hospital mortality didn’t differ between the two groups.

Conclusion

Our findings suggest that patients undergoing 4-hour SLED are more likely to get prescribed antibiotics using IHD-recommended dosing, which resulted in worse clinical outcomes. These findings would encourage using SLED-recommended dosing for 4-hour SLED and might serve as the basis for future larger studies.

Figure 1. Kaplan-Meier curve of recovery from sepsis