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Jager NG, Zandvliet AS, Touw DJ, et al. Optimization of anti-infective dosing regimens during online haemodiafiltration. Clin Kidney J. 2017;10(2):282-290doi: 10.1093/ckj/sfx009.
Jager, N. G., Zandvliet, A. S., Touw, D. J., & Penne, E. L. (2017). Optimization of anti-infective dosing regimens during online haemodiafiltration. Clinical kidney journal, 10(2), 282-290. https://doi.org/10.1093/ckj/sfx009
Jager, Nynke G L, et al. "Optimization of anti-infective dosing regimens during online haemodiafiltration." Clinical kidney journal vol. 10,2 (2017): 282-290. doi: https://doi.org/10.1093/ckj/sfx009
Jager NG, Zandvliet AS, Touw DJ, Penne EL. Optimization of anti-infective dosing regimens during online haemodiafiltration. Clin Kidney J. 2017 Apr;10(2):282-290. doi: 10.1093/ckj/sfx009. Epub 2017 Mar 29. PMID: 28396747; PMCID: PMC5381234.
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Clin Kidney J. 2017 Apr;10(2):282-290. doi: 10.1093/ckj/sfx009. Epub 2017 Mar 29.

Optimization of anti-infective dosing regimens during online haemodiafiltration.

Clinical kidney journal

Nynke G L Jager, Anthe S Zandvliet, Daniel J Touw, Erik L Penne

Affiliations

  1. Department of Clinical Pharmacy, Northwest Clinics, Alkmaar, The Netherlands; Department of Clinical Pharmacology and Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands.
  2. Department of Clinical Pharmacology and Pharmacy, VU Medical Centre, Amsterdam, The Netherlands.
  3. Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
  4. Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands.

PMID: 28396747 PMCID: PMC5381234 DOI: 10.1093/ckj/sfx009

Abstract

Online haemodiafiltration (HDF) is increasingly used in clinical practice as a routine intermittent dialysis modality. It is well known that renal impairment and renal replacement therapy can substantially affect the pharmacokinetic behaviour of several drugs. However, surprisingly few data are available on the need for specific dose adjustments during HDF. Due to convection, drug clearance may be increased during HDF as compared with standard haemodialysis. This may be of particular interest in patients undergoing anti-infective therapy, since under-dosing may compromise patient outcomes and promote the emergence of bacterial resistance. Drug clearance during HDF is determined by (i) dialysis characteristics, (ii) drug characteristics and (iii) patient characteristics. In this review, we will discuss these different determinants of drug clearance during HDF and advise on how to adjust the dose of antibacterial, antimycotic and antiviral agents in patients undergoing HDF. In addition, the possible added value of therapeutic drug monitoring is discussed. The review provides guidance for optimization of anti-infective dosing regimens in HDF patients.

Keywords: anti-infective; antibiotics; antifungals; antivirals; haemodiafiltration

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