Pacientes em hemodiálise ambulatorial : protocolo de administração e monitoramento de níveis séricos de vancomicina

Abstract

Background: The current study aims to test and a vancomycin protocol based on the initial hemodialysis patients weight and to describe drug peak and through serum levels. Methods: A study enrolling 16 ESRD adult patients cohort undergoing hemodialysis received a uniform vancomycin administration schedule: 20 mg/kg initial dose, infused during the last dialysis hour; blood sample collection 30 minutes post-dialysis and, subsequently, before every dialysis session. Additionally, a fixed schedule to adjust every new dose was used. Anthropometric, clinical and laboratory variables were collected. Descriptive statistics was used; Spearman correlation coefficient was used to verify associations. Results: No significant correlation between vancomycin peak serum level and trough levels and the initial dose, nor any trough level and the following doses were uncovered. However, total serum protein strong and positively correlated with the initial Vancomycin dose and the first trough serum level (rs = 0.608, P = 0.016 and rs= 0.641; P = 0.010, respectively). Initial dose positively correlated with albumin too (rs= 0.572, P = 0.02). A strong correlation between the first and second trough levels was also found (rs = 0.608; P = 0.021). Conclusion: As applied, the vancomycin administration protocol was ineffective in reaching and maintaining therapeutic peak and trough levels. It is possible that a significant loss of vancomycin free-fraction by dialysis accounted for such a finding. Correlation of vancomycin serum levels between total serum proteins should be further investigated.