Pharmacokinetics of Meropenem in Critically Ill Patients with Acute Renal Failure Treated by Continuous Hemodiafiltration

ABSTRACT The pharmacokinetics of meropenem were studied in nine anuric critically ill patients treated by continuous venovenous hemodiafiltration. Peak levels after infusion of 1,000 mg over 30 min amounted to 103.2 ± 45.9 μg/ml, and trough levels at 12 h were 9.6 ± 3.8 μg/ml. A dosage of 1,000 mg of meropenem twice a day provides plasma drug levels covering intermediately susceptible microorganisms. Further reductions of the dosage might be appropriate for highly susceptible bacteria or when renal replacement therapies with lower clearances are applied.

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Continuous Venovenous Hemodiafiltration Compared with Conventional Dialysis in Critically Ill Patients with Acute Renal Failure

ASAIO Journal ◽

10.1097/00002480-199339030-00125 ◽

1993 ◽

Vol 39 (3) ◽

pp. M794-M797 ◽

Cited By ~ 23

Author(s):

Rinaldo Bellomo ◽

Neil Boyce

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Critically Ill ◽

Critically Ill Patients ◽

Continuous Venovenous Hemodiafiltration

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A Prospective Study of Continuous Venovenous Hemodiafiltration in Critically Ill Patients with Acute Renal Failure

Journal of Intensive Care Medicine ◽

10.1177/088506669501000405 ◽

1995 ◽

Vol 10 (4) ◽

pp. 187-192 ◽

Cited By ~ 8

Author(s):

Rinaldo Bellomo ◽

Michael Farmer ◽

Neil Boyce

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Confidence Interval ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Apache Ii Score ◽

Continuous Venovenous Hemodiafiltration

We studied the biochemical and the clinical consequences of the application of continuous venovenous hemodiafiltration to the management of acute renal failure in critically ill patients. One hundred consecutive surgical and medical ICU patients with acute renal failure were entered into a prospective clinical study at an intensive care unit of tertiary institution. Intervention included assessment of illness severity by APACHE II score on admission and by organ failure score prior to initiation of renal replacement therapy; treatment of patients with continuous venovenous hemodiafiltration; and measurement of biochemical variables prior to and after therapy. Outcome assessment included incidence of complications, duration of oliguria, duration of intensive care and hospital stays, and survival to hospital discharge. Measurements and main results included the following: mean patient age was 60.9 years (range 21–81 yr); mean APACHE II score, 28.6 (95% confidence interval; 27.4-29.8); and number of failing organs, mean, 4.1 (95% confidence interval; 3.8-4.4). At commencement of continuous venovenous hemofiltration with dialysis, 79% of patients were receiving inotropic drugs and 72% were septic, and, in 35%, bacteremia or fungemia was demonstrated. Renal replacement therapy was applied for a mean duration of 186.2 hours (95% confidence interval; 149.2-223.7), with a mean hourly net ultrafiltrate production of 621 mL (95% confidence interval; 594–648) and a mean urea clearance of 28.1 mL/min (95% confidence interval; 26.7-29.5). Azotemia was controlled in all patients (plasma urea < 30 mmol/L). During the more than 18,000 hours of treatment, there was no therapy-associated hemodynamic instability. Complications were rare. They included two cases of hemofilter rupture with minor blood loss and a single case of bleeding at the site of the vascular-access catheter. Forty-three patients survived to ICU discharge, and 40 survived to hospital discharge. Continuous venovenous hemodiafiltration is a safe and an effective form of renal replacement therapy in critically ill patients. In such patients, who have a high predicted mortality rate, it was associated with a 40% survival rate. These findings suggests that continuous venovenous hemodiafiltration may be ideally suited to patients with multisystem organ failure with acute renal failure.

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Which Amino-Acids do Serum and Hemofiltrate of Critically Ill Patients with Acute Renal Failure Contain?

The International Journal of Artificial Organs ◽

10.1177/039139889702000603 ◽

1997 ◽

Vol 20 (6) ◽

pp. 309-315 ◽

Cited By ~ 2

Author(s):

H-J. Guth ◽

M. Wiersbitzky ◽

M. Ziesche ◽

H-J. Rose ◽

G. Kraatz

Keyword(s):

Amino Acids ◽

Renal Failure ◽

Acute Renal Failure ◽

Lactic Acid ◽

Amino Acid ◽

Parenteral Nutrition ◽

Critically Ill ◽

Critically Ill Patients ◽

Renal Replacement Therapies ◽

Continuous Renal Replacement Therapies

The removal of amino acids during continuous renal replacement therapies induces clinical problems. Previous studies on animals have shown nephroprotective (glycine, alanine) or negative effects (lysine) on renal function in occurrence of acute renal failure. Disturbed metabolism in acute renal failure needs adequate parenteral nutrition. On the other hand, experience with continuous renal replacement therapies of metabolic crises in inborn errors of metabolism indicate a good control of disturbed amino acid metabolism. The aim of our study was to find amino acids, that might play an important role in the pathogenesis, prognosis and detection of acute renal failure and severe illness, so far only estimated by lactic acid. Thirty-three probes (serum and hemofiltrate) were taken from patients, suffering with acute renal failure caused by septic shock, severe pancreatitis and hepatorenal syndrome, one hour after the beginning of extracorporal circulation, the conditions of treatment were standardized. The material was deproteinized and studied by the amino acid analyzer LBK 4251 Apha Plus (Pharmacia, Stockholm, Sweden), while the lactic acid concentration was determined in a standard laboratory. Proline, glycine, alanine, methionine and histidine showed a close relationship to the lactic acid levels, but these amino acids were an essential part of parenteral nutrition. A statistical relationship was also established in (amino acids with amide groups) asparagine, glutamine, citrulline, cystathionine and phosphoethanolamine. The mean values of most of the amino acids were higher than normal, but standard deviations were increased. The presence of these amino acids in hemofiltrate and the good sieving coefficients could mean that the better prognosis of critically ill patients in continuous renal replacement therapies may also be due to continuous control of amino acid levels (especially with amide groups).

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Dialysis in Acute Renal Failure: Is More Better?

The International Journal of Artificial Organs ◽

10.1177/039139880202501201 ◽

2002 ◽

Vol 25 (12) ◽

pp. 1119-1122 ◽

Cited By ~ 2

Author(s):

W.R. Clark ◽

M.A. Kraus

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Critically Ill ◽

Critically Ill Patients ◽

Controlled Trials ◽

Renal Replacement Therapies

An increasing body of evidence indicates therapy dose and intensity influence the outcome of dialyzed ARF patients. However, a number of unanswered questions remain on this issue. These questions need to be addressed in future prospective, controlled trials that assess the effect of dose and intensity on outcome both within and between the various ARF renal replacement therapies, with appropriate and clinically relevant control arms. Such investigations should provide guidelines ultimately for the dialytic management of critically ill patients with ARF.

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