Evaluation of the Vancomycin and Meropenem removal by different dialysis methods in patients with acute kidney injury associated with sepsis

Abstract

Sepsis is the main cause of acute kidney injury (AKI) requiring dialysis support in patients admitted to intensive care unit (ICU) and it represents an independent risk factor for death. Early intervention is essential for reducing mortality. Infection control in the intensive care environment by hospital pathogens often includes the use of vancomycin and meropenem. It is noteworthy that profound changes occur in the pharmacokinetics of antimicrobials prescribed to critical patients and that different dialytic methods may partially or totally remove them, since the pharmacokinetics of these agents is unpredictable under these clinical conditions. Objective: To evaluate the removal of vancomycin and meropenem by different dialysis methods in patients with AKI associated with sepsis. Methodology: A cross-sectional study that will evaluate 50 septic patients and AKI in dialysis and in vancomycin or meropenem treatment admitted to the ICU of Hospital das Clínicas, Botucatu Medical School, UNESP. Serial blood samples will be taken at the beginning of dialysis therapy, after 2 and 4 hours of treatment and at the end of therapy, totaling 8 mL of blood (2 mL / collection of BD / gel vacuum tube). Blood samples will be drawn through a central venous catheter by the dialysis nurse, and the serum will be obtained by centrifugation and maintained at -20 °C until the test. At the end of the patient's last blood collection, the blood samples will be transported from the Hospital das Clínicas of Botucatu Medical School (UNESP) to the Faculty of Sciences (UNESP, Campus de Bauru). Pharmacokinetics will be estimated using PK Solutions 2.0, Noncompartmental Data Analysis, PK-PD modeling for in vivo-in vitro correlation, and statistical treatment will be performed on GraphPad Prism (GraphPad Software Inc., San Diego, CA, USA). Chromatography data will be processed in free Libreoffice® Calc and / or GNU Octave® software. (AU)