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.