Amikacin use in critically ill patients requiring renal replacement therapy: the AMIDIAL-ICU study
Abstract Background Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is common in intensive care units (ICUs), yet optimal amikacin dosing in this context remains poorly understood. Methods We conducted a prospective observational study across 18 French hospitals from April 2020 t...
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SpringerOpen
2025-03-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-025-01461-z |
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| author | Vincent Dupont Bruno Mourvillier Coralie Barbe Vincent Legros Mathieu Jozwiak Hamid Merdji Claire Dupuis Hadrien Winiszewski Antoine Marchalot Guillaume Lacave Mathilde Neuville Anne Sagnier François Barbier Carine Thivilier Stéphanie Ruiz Roland Smonig Jeremy Rosman Laurent Argaud Steven Grangé Benjamine Sarton Patrick Chillet Guillaume Voiriot Lukshe Kanagaratnam Zoubir Djerada |
| author_facet | Vincent Dupont Bruno Mourvillier Coralie Barbe Vincent Legros Mathieu Jozwiak Hamid Merdji Claire Dupuis Hadrien Winiszewski Antoine Marchalot Guillaume Lacave Mathilde Neuville Anne Sagnier François Barbier Carine Thivilier Stéphanie Ruiz Roland Smonig Jeremy Rosman Laurent Argaud Steven Grangé Benjamine Sarton Patrick Chillet Guillaume Voiriot Lukshe Kanagaratnam Zoubir Djerada |
| author_sort | Vincent Dupont |
| collection | DOAJ |
| description | Abstract Background Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is common in intensive care units (ICUs), yet optimal amikacin dosing in this context remains poorly understood. Methods We conducted a prospective observational study across 18 French hospitals from April 2020 to January 2022. Adult ICU patients (aged > 18 years) receiving their first amikacin dose while on RRT were included. Data on demographics, RRT modalities, amikacin dosing, and therapeutic drug monitoring were collected. Using a pharmacokinetic modeling approach, we evaluated various amikacin regimens and simulated target attainment probabilities across different minimum inhibitory concentrations (MICs). Results A total of 111 patients were included, with approximately two-thirds receiving continuous RRT. The median amikacin dose was 27 (25–30) mg/kg. Amikacin peak (Cmax) and trough concentrations were monitored in 53 (47.8%) and 76 (68.5%) patients, respectively. Continuous RRT and a history of chronic kidney disease reduced dialytic clearance. For a MIC ≤ 4 mg/L, a 15 mg/kg amikacin dose achieved Cmax/MIC and AUC/MIC targets in ≥ 90% of patients on intermittent dialysis, while 20 mg/kg was required for those on continuous dialysis. For a MIC = 8 mg/L, a 30 mg/kg dose was necessary to achieve Cmax/MIC ≥ 8. Conclusions Our findings highlight suboptimal adherence to amikacin monitoring guidelines in ICU patients on RRT. Using pharmacokinetic modeling, we identified amikacin dosing recommendations ranging from 15 to 35 mg/kg to optimize efficacy and minimize risks, depending on MIC and dialysis modality. |
| format | Article |
| id | doaj-art-76a08cd1575d420d9edb4117066e3ceb |
| institution | DOAJ |
| issn | 2110-5820 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | SpringerOpen |
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| series | Annals of Intensive Care |
| spelling | doaj-art-76a08cd1575d420d9edb4117066e3ceb2025-08-20T02:49:01ZengSpringerOpenAnnals of Intensive Care2110-58202025-03-011511710.1186/s13613-025-01461-zAmikacin use in critically ill patients requiring renal replacement therapy: the AMIDIAL-ICU studyVincent Dupont0Bruno Mourvillier1Coralie Barbe2Vincent Legros3Mathieu Jozwiak4Hamid Merdji5Claire Dupuis6Hadrien Winiszewski7Antoine Marchalot8Guillaume Lacave9Mathilde Neuville10Anne Sagnier11François Barbier12Carine Thivilier13Stéphanie Ruiz14Roland Smonig15Jeremy Rosman16Laurent Argaud17Steven Grangé18Benjamine Sarton19Patrick Chillet20Guillaume Voiriot21Lukshe Kanagaratnam22Zoubir Djerada23Centre Hospitalier Universitaire de ReimsCentre Hospitalier Universitaire de ReimsUniversité de Reims Champagne ArdenneCentre Hospitalier Universitaire de ReimsUnité de Recherche Clinique Côte d’Azur, Centre Hospitalier Universitaire de Nice, Université Côte d’AzurCentre Hospitalier Universitaire de StrasbourgCentre Hospitalier Universitaire de Clermont FerrandCentre Hospitalier Universitaire de BesançonCentre Hospitalier de DieppeCentre Hospitalier de VersaillesHopital FochCentre Hospitalier de BeauvaisCentre Hospitalier Universitaire d’OrléansCentre Hospitalier Universitaire de NancyCentre Hospitalier Universitaire de ToulouseCentre Hospitalier de LorientCentre Hospitalier Intercommunal Nord ArdennesCentre Hospitalier Universitaire de LyonCentre Hospitalier Universitaire de RouenCentre Hospitalier Universitaire de ToulouseCentre Hospitalier de Chalons en ChampagneService de Médecine Intensive Réanimation, Sorbonne Université, Centre de Recherche Saint-Antoine UMRS_938 INSERM, Assistance Publique– Hôpitaux de Paris, Hôpital TenonCentre Hospitalier Universitaire de ReimsCentre Hospitalier Universitaire de ReimsAbstract Background Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is common in intensive care units (ICUs), yet optimal amikacin dosing in this context remains poorly understood. Methods We conducted a prospective observational study across 18 French hospitals from April 2020 to January 2022. Adult ICU patients (aged > 18 years) receiving their first amikacin dose while on RRT were included. Data on demographics, RRT modalities, amikacin dosing, and therapeutic drug monitoring were collected. Using a pharmacokinetic modeling approach, we evaluated various amikacin regimens and simulated target attainment probabilities across different minimum inhibitory concentrations (MICs). Results A total of 111 patients were included, with approximately two-thirds receiving continuous RRT. The median amikacin dose was 27 (25–30) mg/kg. Amikacin peak (Cmax) and trough concentrations were monitored in 53 (47.8%) and 76 (68.5%) patients, respectively. Continuous RRT and a history of chronic kidney disease reduced dialytic clearance. For a MIC ≤ 4 mg/L, a 15 mg/kg amikacin dose achieved Cmax/MIC and AUC/MIC targets in ≥ 90% of patients on intermittent dialysis, while 20 mg/kg was required for those on continuous dialysis. For a MIC = 8 mg/L, a 30 mg/kg dose was necessary to achieve Cmax/MIC ≥ 8. Conclusions Our findings highlight suboptimal adherence to amikacin monitoring guidelines in ICU patients on RRT. Using pharmacokinetic modeling, we identified amikacin dosing recommendations ranging from 15 to 35 mg/kg to optimize efficacy and minimize risks, depending on MIC and dialysis modality.https://doi.org/10.1186/s13613-025-01461-zAmikacinAminoglycosideRenal replacement therapyIntensive care unitPharmacokinetic |
| spellingShingle | Vincent Dupont Bruno Mourvillier Coralie Barbe Vincent Legros Mathieu Jozwiak Hamid Merdji Claire Dupuis Hadrien Winiszewski Antoine Marchalot Guillaume Lacave Mathilde Neuville Anne Sagnier François Barbier Carine Thivilier Stéphanie Ruiz Roland Smonig Jeremy Rosman Laurent Argaud Steven Grangé Benjamine Sarton Patrick Chillet Guillaume Voiriot Lukshe Kanagaratnam Zoubir Djerada Amikacin use in critically ill patients requiring renal replacement therapy: the AMIDIAL-ICU study Annals of Intensive Care Amikacin Aminoglycoside Renal replacement therapy Intensive care unit Pharmacokinetic |
| title | Amikacin use in critically ill patients requiring renal replacement therapy: the AMIDIAL-ICU study |
| title_full | Amikacin use in critically ill patients requiring renal replacement therapy: the AMIDIAL-ICU study |
| title_fullStr | Amikacin use in critically ill patients requiring renal replacement therapy: the AMIDIAL-ICU study |
| title_full_unstemmed | Amikacin use in critically ill patients requiring renal replacement therapy: the AMIDIAL-ICU study |
| title_short | Amikacin use in critically ill patients requiring renal replacement therapy: the AMIDIAL-ICU study |
| title_sort | amikacin use in critically ill patients requiring renal replacement therapy the amidial icu study |
| topic | Amikacin Aminoglycoside Renal replacement therapy Intensive care unit Pharmacokinetic |
| url | https://doi.org/10.1186/s13613-025-01461-z |
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