Kidney Week

Abstract: TH-PO0828

Population Pharmacokinetics of Teicoplanin in Critically Ill Patients Undergoing CKRT: Effect of Residual Kidney Function and Effluent Flow Rate on Drug Clearance

Session Information

• Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

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

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

Authors

• Lee, Hye Kwan, Yonsei University Institute of Kidney Disease, Seodaemun-gu, Seoul, Korea (the Republic of)

Hye Kwan Lee, DrMed

• Kim, Hyung Woo, Yonsei University Institute of Kidney Disease, Seodaemun-gu, Seoul, Korea (the Republic of)

Hyung Woo Kim, MD

• Ko, Byounghwi, Yonsei University Institute of Kidney Disease, Seodaemun-gu, Seoul, Korea (the Republic of)

Byounghwi Ko

• Park, Cheol Ho, Yonsei University Institute of Kidney Disease, Seodaemun-gu, Seoul, Korea (the Republic of)

Cheol Ho Park, MD, PhD

• Koh, Hee Byung, Yonsei University Institute of Kidney Disease, Seodaemun-gu, Seoul, Korea (the Republic of)

Hee Byung Koh, MD

• Park, Jung Tak, Yonsei University Institute of Kidney Disease, Seodaemun-gu, Seoul, Korea (the Republic of)

Jung Tak Park, MD, PhD

• Han, Seung Hyeok, Yonsei University Institute of Kidney Disease, Seodaemun-gu, Seoul, Korea (the Republic of)

Seung Hyeok Han, MD, PhD

• Kang, Shin-Wook, Yonsei University Institute of Kidney Disease, Seodaemun-gu, Seoul, Korea (the Republic of)

Shin-Wook Kang, MD, PhD

• Yoo, Tae-Hyun, Yonsei University Institute of Kidney Disease, Seodaemun-gu, Seoul, Korea (the Republic of)

Tae-Hyun Yoo, MD, PhD

Background

Optimal teicoplanin dosing in CKRT remains unclear. We developed a population pharmacokinetic model and derived recommendations using probability of target attainment (PTA).

Methods

Nine critically ill adults receiving teicoplanin during CVVHDF were prospectively enrolled. One excluded for implausible pre-dose concentration. Plasma and dialysate samples were collected at pre-dose, 1, 2, 4 h post-dose, and pre-next-dose trough. A two-compartment population PK model was developed in Monolix Suite 2024R1; tested body weight, creatinine clearance (CrCL) at CKRT initiation, and time-varying effluent flow as covariates. Monte Carlo simulations (Simulx; 1,000/scenario) projected PTA across doses (200, 400, 600 mg), body weight (40–80 kg), CrCL (10–60 mL/min), and effluent flow (1,600–3,200 mL/h); targets were trough ≥15 and >40 μg/mL.

Results

Teicoplanin disposition was best described by a two-compartment model with parallel non-dialytic (CL) and dialytic (CLd) clearance. CrCL at CKRT initiation and effluent flow rate were significant covariates on CL and CLd, respectively. The 200 mg regimen yielded subtherapeutic troughs (5–14 μg/mL); however, higher doses exceeded 40 μg/mL in patients with severely impaired CrCL, low weight, and low-intensity CKRT, making 200 mg the only safe option. The 400 mg regimen achieved troughs of 18–28 μg/mL at CrCL ≤20 mL/min but fell below target when effluent flow exceeded 2,700 mL/h or weight exceeded 60 kg. Only the 600 mg regimen maintained troughs ≥15 μg/mL at CrCL ≥30 mL/min with ≥90% PTA under high-intensity CKRT.

Conclusion

In patients receiving CKRT, teicoplanin concentration may vary according to patient condition and CKRT dose, highlighting the need for tailored dosing strategies. Larger studies are warranted.