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Vancomycin Pharmacokinetics in Oliguric Patients Undergoing Continuous Venovenous Hemodialysis and Continuous Venovenous Hemodiafiltration

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dc.contributor.author박, 인휘-
dc.contributor.author이, 선아-
dc.contributor.author임, 승관-
dc.contributor.author유, 수경-
dc.contributor.author장, 은정-
dc.contributor.author문, 은준-
dc.contributor.author황, 주안-
dc.contributor.author김, 흥수-
dc.contributor.author신, 규태-
dc.description.abstract목적:지속적 신대체요법이 사용되고 있는 환자들에게서는 vancomycin 치료가 필요한 경우가 흔하지만, 연속적 정정맥 혈액투석 (continuous venovenous hemodialysis, CVVHD) 또는 연속적 정정맥 혈액여과투석 (continuous venovenous hemodiafiltration, CVVHDF)을 받고 있는 국내 환자를 대상으로 한 약동학적 연구는 부족한 실정이다. 이에 저자들은 이러한 환자들에게서 vancomycin의 약동학적 변수에 관하여 연구 했다.

대상 및 방법: 2008년 1월 1일부터 2009년 12월 31일까지 CVVHD 또는 CVVHDF 치료를 받고 있고, 핍뇨가 있는 환자중 vancomycin이 항정 상태에서 혈중 농도가 측정된 23명 35예를 대상으로 일반적 특성과 약동학적 지표를 분석했다.

결과: CVVHD가 사용된 8예와 CVVHDF가 사용된 27예에서 분석이 가능 했다. 신대체요법의 정도는 CVVHD군에서 17.7±4.9 mL/h/kg 였고, CVVHDF군에서는 32.1±3.9mL/h/kg 였다 (p=0.000). Vancomycin의 청소율은 CVV HD군에서 16.4±3.8 mL/min, CVVHDF에서는 21.6±5.1mL/min 였다 (p=0.007). Vancomycin의 체내 제거율과 CVVHD와 CVVHDF의 배액 속도간에는 의미 있는 비례 관계가 있었다 (CVVHD; r2=0.745, p=0.012, CVVHDF; r2=0.452, p=0.000).

결론:CVVHD와 CVVHDF는 체내로 투여된 vancomycin을 효과적으로 청소시키고 있었고, vancomycin의 청소율은 지속적 신대체요법의 정도에 비례하였으므로, vancomycin 투여 용량 결정시 이를 중심으로 약동학적 관련 요소가 고려되어야 한다.
dc.description.abstractPurpose:Critically ill patients receiving continuous renal replacement therapy are susceptible to infection with methicillin-resistant bacteria, which require treatment with vancomycin. However, there are limited reports regarding vancomycin pharmacokinetics in the continuous venovenous hemodialysis (CVVHD) and continuous venovenous hemodiafiltration (CVVHDF). We performed this study to investigate the pharmacokinetics of vancomycin in oliguric patients receiving CVVHD and CVVHDF.

Methods:Data at steady-state obtained as part of our routine drug monitoring of vancomycin therapy in critically ill adult oliguric patients undergoing CVVHD or CVVHDF, retrospectively. Data were available for 35 cases of 23 patients assessed for 2 years. We analyzed the pharmacokinetic parameters of these cases.

Results:8 cases on CVVHD and 27 cases on CVVHDF were available. The mean intensity of CVVHD was 17.7±4.9 mL/hour/kg and that of CVVHDF was 32.1±3.9 mL/hour/kg (p=0.000). The mean clearance of vancomycin was 16.4±3.8 mL/min in the CVVHD group and 21.6±5.1 mL/min in the CVVHDF group (P=0.007). The elimination of vancomycin correlated with the intensity of CVVHD and CVVHDF (CVVHD; r2=0.745, p=0.012, CVVHDF; r2=0.452, p=0.000).

Conclusions:CVVHD and CVVHDF are effective for vancomycin elimination and there is a strong dependency of the vancomycin removal on the intensity of continuous renal replacement therapy. Strategies for individualization of vancomycin therapy in patients receiving CVVHD and CVVHDF are proposed.
dc.titleVancomycin Pharmacokinetics in Oliguric Patients Undergoing Continuous Venovenous Hemodialysis and Continuous Venovenous Hemodiafiltration-
dc.title.alternative지속적정정맥투석요법과 지속적정정맥여과투석을 사용하는 핍뇨 환자에서 vancomycin의 약동학적 변수 관찰-
dc.subject.keywordRenal replacement therapy-
dc.contributor.affiliatedAuthor박, 인휘-
dc.contributor.affiliatedAuthor임, 승관-
dc.contributor.affiliatedAuthor유, 수경-
dc.contributor.affiliatedAuthor문, 은준-
dc.contributor.affiliatedAuthor황, 주안-
dc.contributor.affiliatedAuthor김, 흥수-
dc.contributor.affiliatedAuthor신, 규태-
dc.type.localJournal Papers-
dc.citation.titleTaehan Sinjang Hakhoe chi-
dc.citation.titleThe Korean journal of nephrology-
dc.identifier.bibliographicCitationTaehan Sinjang Hakhoe chi, 29(5):585-592, 2010-
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Infectious Diseases
Journal Papers > School of Medicine / Graduate School of Medicine > Gastroenterology
Journal Papers > School of Medicine / Graduate School of Medicine > Nephrology
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