Enhanced clearance of vancomycin by hemodialysis in a child

Clearance of vancomycin by hemodialysis has previously been reported to be negligible. We describe a child undergoing chronic hemodialysis using a hollow fiber dialyzer with cellulose acetate membrane. When the patient was treated with intravenous vancomycin for staphylococcal bacteremia, the serum vancomycin half-life was found to decrease by more than 90% during each course of hemodialysis. We conclude that, contrary to prevailing opinion, vancomycin can be rapidly cleared by hemodialysis in the small pediatric patient, and that the dosage should be adjusted accordingly.     

Effects of haemodialysis and continuous ambulatory peritoneal dialysis on the plasma clearance of an albumin-bound furan dicarboxylic acid

Organic acids that are strongly bound to albumin are not removedby dialysis and the plasma concentrations of one such substance,a furan dicarboxylic acid (3-carboxy-4-methyl-5-propyl-2-furan-propanoicacid; 5-propyl FPA) have been measured by HPLC in healthy subjects(n=21), patients on regular haemodialysis (n=30), and patientstreated by continuous ambulatory peritoneal dialysis (n=21).The mean (±SD) concentrations of 5-propyl FPA were significantlyhigher in haemodialysis (95±44 µM) compared toCAPD patients (28±19 µM)) and both were higherthan in healthy individuals (14±7 µM). Haemoglobinconcentrations in CAPD patients were significantly higher thanin those on haemodialysis while these patients had significantlyhigher albumin concentrations than CAPD patients. The concentrationof 5-propyl FPA was positively correlated with the durationof dialysis for haemodialysis patients but not for CAPD patients.The lower concentrations of 5-propyl FPA in CAPD patients mayat least partly explain the higher haemoglobin levels foundin these patients.