Enhanced renal clearance and impact on vancomycin pharmacokinetic parameters in patients with hemorrhagic stroke
Abstract Background The majority of patients with hemorrhagic stroke experience enhanced renal clearance or augmented renal clearance (ARC). The purpose of this study was to determine the impact of enhanced renal clearance or ARC on vancomycin pharmacokinetic (PK) parameters. Methods This was a post...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-11-01
|
| Series: | Journal of Intensive Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40560-019-0408-y |
| _version_ | 1828959150777827328 |
|---|---|
| author | Kathryn A. Morbitzer Denise H. Rhoney Kelly A. Dehne J. Dedrick Jordan |
| author_facet | Kathryn A. Morbitzer Denise H. Rhoney Kelly A. Dehne J. Dedrick Jordan |
| author_sort | Kathryn A. Morbitzer |
| collection | DOAJ |
| description | Abstract Background The majority of patients with hemorrhagic stroke experience enhanced renal clearance or augmented renal clearance (ARC). The purpose of this study was to determine the impact of enhanced renal clearance or ARC on vancomycin pharmacokinetic (PK) parameters. Methods This was a post hoc analysis of a prospective study of adult patients with aneurysmal subarachnoid hemorrhage (aSAH) or intracerebral hemorrhage (ICH) admitted to the neurosciences intensive care unit who received vancomycin. Creatinine clearance (CrCl) was measured and also estimated using the Cockcroft-Gault equation. Predicted PK parameters were compared with calculated PK parameters using serum peak and trough concentrations. Results Seventeen hemorrhagic stroke patients met inclusion criteria. All patients experienced enhanced renal clearance on the day that the vancomycin concentrations were obtained, and 12 patients (71%) experienced ARC. The mean calculated elimination rate constant was significantly higher than the predicted value (0.141 ± 0.02 vs. 0.087 ± 0.01 h−1; p = 0.004) and the mean calculated half-life was significantly lower than the predicted half-life (6.5 ± 0.9 vs. 8.7 ± 0.6 h; p = 0.03). Conclusions Patients with hemorrhagic stroke and enhanced renal clearance displayed PK alterations favoring an increased elimination of vancomycin than expected. This may result in underexposure to vancomycin, leading to treatment failure. |
| first_indexed | 2024-12-14T09:02:27Z |
| format | Article |
| id | doaj.art-62ec7d1de9ac4b55808a2d51fcf7a0c4 |
| institution | Directory Open Access Journal |
| issn | 2052-0492 |
| language | English |
| last_indexed | 2024-12-14T09:02:27Z |
| publishDate | 2019-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj.art-62ec7d1de9ac4b55808a2d51fcf7a0c42022-12-21T23:08:47ZengBMCJournal of Intensive Care2052-04922019-11-01711610.1186/s40560-019-0408-yEnhanced renal clearance and impact on vancomycin pharmacokinetic parameters in patients with hemorrhagic strokeKathryn A. Morbitzer0Denise H. Rhoney1Kelly A. Dehne2J. Dedrick Jordan3Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel HillDivision of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel HillDepartment of Pharmacy, UNC Health CareDivision of Neurocritical Care, Departments of Neurology and Neurosurgery, University of North Carolina School of MedicineAbstract Background The majority of patients with hemorrhagic stroke experience enhanced renal clearance or augmented renal clearance (ARC). The purpose of this study was to determine the impact of enhanced renal clearance or ARC on vancomycin pharmacokinetic (PK) parameters. Methods This was a post hoc analysis of a prospective study of adult patients with aneurysmal subarachnoid hemorrhage (aSAH) or intracerebral hemorrhage (ICH) admitted to the neurosciences intensive care unit who received vancomycin. Creatinine clearance (CrCl) was measured and also estimated using the Cockcroft-Gault equation. Predicted PK parameters were compared with calculated PK parameters using serum peak and trough concentrations. Results Seventeen hemorrhagic stroke patients met inclusion criteria. All patients experienced enhanced renal clearance on the day that the vancomycin concentrations were obtained, and 12 patients (71%) experienced ARC. The mean calculated elimination rate constant was significantly higher than the predicted value (0.141 ± 0.02 vs. 0.087 ± 0.01 h−1; p = 0.004) and the mean calculated half-life was significantly lower than the predicted half-life (6.5 ± 0.9 vs. 8.7 ± 0.6 h; p = 0.03). Conclusions Patients with hemorrhagic stroke and enhanced renal clearance displayed PK alterations favoring an increased elimination of vancomycin than expected. This may result in underexposure to vancomycin, leading to treatment failure.http://link.springer.com/article/10.1186/s40560-019-0408-ySubarachnoid hemorrhageIntracerebral hemorrhageAugmented renal clearanceCreatinine clearanceVancomycin |
| spellingShingle | Kathryn A. Morbitzer Denise H. Rhoney Kelly A. Dehne J. Dedrick Jordan Enhanced renal clearance and impact on vancomycin pharmacokinetic parameters in patients with hemorrhagic stroke Journal of Intensive Care Subarachnoid hemorrhage Intracerebral hemorrhage Augmented renal clearance Creatinine clearance Vancomycin |
| title | Enhanced renal clearance and impact on vancomycin pharmacokinetic parameters in patients with hemorrhagic stroke |
| title_full | Enhanced renal clearance and impact on vancomycin pharmacokinetic parameters in patients with hemorrhagic stroke |
| title_fullStr | Enhanced renal clearance and impact on vancomycin pharmacokinetic parameters in patients with hemorrhagic stroke |
| title_full_unstemmed | Enhanced renal clearance and impact on vancomycin pharmacokinetic parameters in patients with hemorrhagic stroke |
| title_short | Enhanced renal clearance and impact on vancomycin pharmacokinetic parameters in patients with hemorrhagic stroke |
| title_sort | enhanced renal clearance and impact on vancomycin pharmacokinetic parameters in patients with hemorrhagic stroke |
| topic | Subarachnoid hemorrhage Intracerebral hemorrhage Augmented renal clearance Creatinine clearance Vancomycin |
| url | http://link.springer.com/article/10.1186/s40560-019-0408-y |
| work_keys_str_mv | AT kathrynamorbitzer enhancedrenalclearanceandimpactonvancomycinpharmacokineticparametersinpatientswithhemorrhagicstroke AT denisehrhoney enhancedrenalclearanceandimpactonvancomycinpharmacokineticparametersinpatientswithhemorrhagicstroke AT kellyadehne enhancedrenalclearanceandimpactonvancomycinpharmacokineticparametersinpatientswithhemorrhagicstroke AT jdedrickjordan enhancedrenalclearanceandimpactonvancomycinpharmacokineticparametersinpatientswithhemorrhagicstroke |