In vitro elimination of antimicrobials during ADVanced Organ Support hemodialysis
BackgroundAcute kidney injury (AKI) requiring continuous renal replacement therapy is common in critically ill patients. The ADVanced Organ Support (ADVOS) system is a novel hemodialysis machine that uses albumin enriched dialysate which allows the removal of protein-bound toxins and drugs. To date,...
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Frontiers Media S.A.
2024-12-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2024.1447511/full |
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| author | Christina König Christina König Otto Frey Susanne Himmelein Lisa Mulack Alexander Brinkmann Aritz Perez Ruiz de Garibay Tobias Bingold |
| author_facet | Christina König Christina König Otto Frey Susanne Himmelein Lisa Mulack Alexander Brinkmann Aritz Perez Ruiz de Garibay Tobias Bingold |
| author_sort | Christina König |
| collection | DOAJ |
| description | BackgroundAcute kidney injury (AKI) requiring continuous renal replacement therapy is common in critically ill patients. The ADVanced Organ Support (ADVOS) system is a novel hemodialysis machine that uses albumin enriched dialysate which allows the removal of protein-bound toxins and drugs. To date, data on antimicrobial removal under ADVOS has not yet been reported.MethodsAn in vitro study was conducted using whole porcine blood and continuous infusions of different antimicrobial agents to investigate the effect of ADVOS on drug exposure. Drugs with varying protein binding, molecular weights and renal clearances, anidulafungin, cefotaxime, daptomycin, fluconazole, ganciclovir, linezolid, meropenem and piperacillin were studied.ResultsAll studied drugs were removed during the in vitro ADVOS experiment. Clearance under ADVOS (CLADVOS) for low protein-bound drugs, such as cefotaxime, fluconazole, ganciclovir, linezolid, meropenem and piperacillin ranged from 2.74 to 3.4 L/h at a blood flow of 100 mL/min. With a doubling of flow rate CL for these drugs increased. Although efficiently removed, this effect was not seen for CLADVOS in high protein-bound substances such as daptomycin (1.36 L/h) and anidulafungin (0.84 L/h).ConclusionThe ADVOS system effectively removed protein-bound and unbound antimicrobials to a significant extent indicating that dose adjustments are required. Further, clinical studies are necessary to comprehensively assess the impact of ADVOS on antimicrobial drug removal. Until clinical data are available, therapeutic drug monitoring should guide antimicrobial dosing under ADVOS. |
| format | Article |
| id | doaj-art-815818ac3caf4dd2b33f67e160eaa91a |
| institution | OA Journals |
| issn | 1663-9812 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj-art-815818ac3caf4dd2b33f67e160eaa91a2025-08-20T02:35:47ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122024-12-011510.3389/fphar.2024.14475111447511In vitro elimination of antimicrobials during ADVanced Organ Support hemodialysisChristina König0Christina König1Otto Frey2Susanne Himmelein3Lisa Mulack4Alexander Brinkmann5Aritz Perez Ruiz de Garibay6Tobias Bingold7Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyCenter for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, United StatesDepartment of Pharmacy, General Hospital of Heidenheim, Heidenheim, GermanyADVITOS GmbH, Munich, GermanyDepartment of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Anesthesiology, Special Pain Management and Intensive Care Medicine, Heidenheim General Hospital, Heidenheim, GermanyADVITOS GmbH, Munich, GermanyADVITOS GmbH, Munich, GermanyBackgroundAcute kidney injury (AKI) requiring continuous renal replacement therapy is common in critically ill patients. The ADVanced Organ Support (ADVOS) system is a novel hemodialysis machine that uses albumin enriched dialysate which allows the removal of protein-bound toxins and drugs. To date, data on antimicrobial removal under ADVOS has not yet been reported.MethodsAn in vitro study was conducted using whole porcine blood and continuous infusions of different antimicrobial agents to investigate the effect of ADVOS on drug exposure. Drugs with varying protein binding, molecular weights and renal clearances, anidulafungin, cefotaxime, daptomycin, fluconazole, ganciclovir, linezolid, meropenem and piperacillin were studied.ResultsAll studied drugs were removed during the in vitro ADVOS experiment. Clearance under ADVOS (CLADVOS) for low protein-bound drugs, such as cefotaxime, fluconazole, ganciclovir, linezolid, meropenem and piperacillin ranged from 2.74 to 3.4 L/h at a blood flow of 100 mL/min. With a doubling of flow rate CL for these drugs increased. Although efficiently removed, this effect was not seen for CLADVOS in high protein-bound substances such as daptomycin (1.36 L/h) and anidulafungin (0.84 L/h).ConclusionThe ADVOS system effectively removed protein-bound and unbound antimicrobials to a significant extent indicating that dose adjustments are required. Further, clinical studies are necessary to comprehensively assess the impact of ADVOS on antimicrobial drug removal. Until clinical data are available, therapeutic drug monitoring should guide antimicrobial dosing under ADVOS.https://www.frontiersin.org/articles/10.3389/fphar.2024.1447511/fullextracorporeal organ supportpharmacokineticsantibioticrenal replacement therapydrug monitoring |
| spellingShingle | Christina König Christina König Otto Frey Susanne Himmelein Lisa Mulack Alexander Brinkmann Aritz Perez Ruiz de Garibay Tobias Bingold In vitro elimination of antimicrobials during ADVanced Organ Support hemodialysis Frontiers in Pharmacology extracorporeal organ support pharmacokinetics antibiotic renal replacement therapy drug monitoring |
| title | In vitro elimination of antimicrobials during ADVanced Organ Support hemodialysis |
| title_full | In vitro elimination of antimicrobials during ADVanced Organ Support hemodialysis |
| title_fullStr | In vitro elimination of antimicrobials during ADVanced Organ Support hemodialysis |
| title_full_unstemmed | In vitro elimination of antimicrobials during ADVanced Organ Support hemodialysis |
| title_short | In vitro elimination of antimicrobials during ADVanced Organ Support hemodialysis |
| title_sort | in vitro elimination of antimicrobials during advanced organ support hemodialysis |
| topic | extracorporeal organ support pharmacokinetics antibiotic renal replacement therapy drug monitoring |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2024.1447511/full |
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