A case of vancomycin clearance during sustained low-efficiency diafiltration (SLED-f) for sepsis

Abstract

There is very little information on pharmacokinetics during sustained low-efficiency diafiltration (SLED-f), and no dosage standard for vancomycin (VCM) has been established. This report describes a case in which blood VCM levels were measured before and after SLED-f to determine VCM clearance. The patient was on maintenance dialysis for end-stage renal failure and was rushed to our hospital because of respiratory distress and swelling of the entire face. Pulmonary edema was observed and sepsis associated with left orbital cellulitis was diagnosed. Two grams of VCM (28 mg/kg) was administered as the initial dose, and SLED-f was performed 30 min after the end of administration. The SLED-f hemofilter membrane material was polymethyl methacrylate (1.8 m²), with settings of blood flow rate 200 mL/min, dialysate flow rate 2 L/h, filtration flow rate 2.9 L/h, and replacement flow rate 2.5 L/h. Dialysis time was 6 h. The blood VCM levels immediately before the start of SLED-f and 1 h after the end of SLED-f were 63.3 μg/mL and 22.0 μg/mL, respectively. VCM clearance calculated from the obtained VCM concentration was 5.56 L/h, equivalent to normal renal function. This study reported only one case, and further data accumulation is required to clarify the relationship between SLED-f dialysis and VCM clearance and to accumulate useful information for dosing regimens.