Dosing Recommendations for Continuous Venovenous Hemodiafiltration: RESULTS
Twenty-five studies were identified that included data on the pharmacokinetics of medications for patients undergoing CVVHDF with AN69 filter membranes and a Gambro, Hospal, or Prisma dialyzer. One study on cefepime was excluded because the data indicated that CVVHDF clearance was greater than total body clearance for the study population, an impossible result. The methods used for studies of glutamine, folic acid, and pyridoxal-5′-phosphate did not allow determination of pharmacokinetic parameters specific to CVVHDF, and these studies were also excluded. Therefore, a total of 22 studies of 14 medications were included in the final review (Table 1).
Table 1. Pharmacokinetic Parameters for Patients Undergoing Continuous Venovenous Hemodiafiliation with Prismaflex Dialyzer and AN69 Membrane Filters
For each of the 14 medications, the total clearance and elimination constant (Ke) for healthy patients were extracted (Table 2), as well as the usual dosing for critically ill patients (Table 3). For drugs that were reported in more than one study, for which more than one value for total clearance was found, the mean total clearance was calculated. The mean total clearances for each medication in healthy patients and in patients undergoing CVVHDF were used to generate dosage adjustments for patients undergoing CVVHDF (Table 3). For most drugs, the total clearance during CVVHDF was less than the clearance in normal patients with presumed normal renal function. Two exceptions were fluconazole and moxifloxacin, which had greater total clearance during CVVHDF; however, a dose adjustment during CVVHDF was deemed necessary only for fluconazole.
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Table 2. Pharmacokinetic Parameters in Healthy Patients
Table 3. Dosing Recommendations for Continuous Venovenous Hemodiafiltration (CVVHDF) Based on Total Clearance with Prismaflex Dialyzer and AN69 Membrane Filters
