Amikacin pharmacokinetics during continuous veno-venous hemodialysis.

INTRODUCTION: Little is known about the pharmacokinetics of amikacin during continuous renal replacement therapy.

METHODS: This prospective observational study included patients admitted to an academic medical center who received amikacin therapy while on continuous veno-venous hemodialysis (CVVHD) and had at least two serum sample concentrations measured after first-dose administration. First-order pharmacokinetic parameters, patient characteristics, and CVVHD parameters were recorded.

RESULTS: Fifteen patients were included in the analysis. The median (interquartile range) dose of amikacin and dialysate flow rate, based on adjusted body weight, were 14.1 mg/kg (11.7-17.3 mg/kg) and 23.9 mL/kg/h (19.0-29.5 mL/kg/h), respectively. This corresponded with a median C max of 28.5 μg/mL (20.9-39.0 μg/mL). There was a significant correlation between clearance and dialytic dose (for every 1 L/h increase in dialysate flow rate, clearance rate increased by 23.6 mL/min [95% confidence interval 1.7-45.4 mL/min; P = 0.037]).

CONCLUSION: The results of this study suggest that amikacin dose and interval should be individualized for each patient on CVVHD based on first-dose pharmacokinetic assessment.