Contribution of diafiltration and adsorption to vancomycin clearance in a continuous hemodiafiltration circuit model in vitro
Contribution of diafiltration and adsorption to vancomycin clearance in a continuous hemodiafiltration circuit model in vitro
复制标题
体外连续血液透析滤过回路模型中透析滤过和吸附对万古霉素清除率的贡献
DOI：
10.1111/aor.14178
复制
发表时间：
2022
影响因子：
2.4
通讯作者：
Ishii Itsuko
中科院分区：
文献类型：
--
作者：
Uchida Masashi;Sawada Mifuyu;Yamazaki Shingo;Suzuki Tatsuya;Suzuki Takaaki;Ishii Itsuko
万古霉素（VCM）在连续血液滤过（CHDF）中主要通过滤过去除，但用聚乙烯亚胺（AN69ST）包覆的聚丙烯腈和甲基磺酸钠共聚物膜或聚甲基丙烯酸甲酯（PMMA）膜对VCM的CHDF清除（CLCHDF）的吸附贡献尚不清楚。本研究旨在探讨AN69ST和PMMA膜的体外滤除和吸附对VCM的clchdf的贡献。方法建立体外CHDF回路模型。VCM初始浓度为50 μg/mL，制备的人血清白蛋白（HSA）浓度为0、2.5、5.0 g/dL。出水流速（Qe）设置为800、1500或3000 mL/h。计算了CLCHDF、VCM的滤除率和吸附率。结果AN69ST膜VCM的总clchdf分别随着Qe和HSA浓度的增加而升高和降低。各条件下的滤过率和吸附率分别为82.1±9.8%和12.1±6.1%。随着Qe的增加，PMMA膜的clchd总量增加。各条件下的滤过率和吸附率分别为89.2±20.4%和4.6±17.0%。观察到的CLCHDF值与预测的CLCHDF值显著相关，CLCHDF是根据先前的研究计算的，作为Qe和等离子体未结合分数的乘积。结论AN69ST膜和PMMA膜的滤过作用对VCM的clchdf起主要作用。当滤过作用而非吸附作用是VCM的clchdf的主要作用时，至少在体外，可以通过Qe和HSA浓度来预测clchdf。
BackgroundVancomycin (VCM) is eliminated mainly by diafiltration under continuous hemodiafiltration (CHDF), but the contribution of adsorption to CHDF clearance (CLCHDF) of VCM using a polyacrylonitrile and sodium methallyl sulfonate copolymer membrane coated with polyethylenimine (AN69ST) or a polymethylmethacrylate (PMMA) membrane is unknown. This study sought to investigate the contribution of diafiltration and adsorption to the CLCHDFof VCM using AN69ST and PMMA membranes in vitro.MethodsAn in vitro CHDF circuit model was developed. The initial concentration of VCM was 50 μg/mL and human serum albumin (HSA) was prepared at a concentration of 0, 2.5, or 5.0 g/dL. The effluent flow rate (Qe) was set at 800, 1500, or 3000 mL/h. The CLCHDF, diafiltration rate, and adsorption rate of VCM were calculated.ResultsTotal CLCHDFof VCM using the AN69ST membrane increased and decreased with increasing Qe and HSA concentration, respectively. Diafiltration and adsorption rates were 82.1 ± 9.8% and 12.1 ± 6.1% under all conditions, respectively. Total CLCHDFusing the PMMA membrane increased with increasing Qe. Diafiltration and adsorption rates were 89.2 ± 20.4% and 4.6 ± 17.0% under all conditions, respectively. The observed CLCHDFvalues significantly correlated with the predicted CLCHDF, calculated according to a previous study as the product of Qe and the plasma unbound fraction.ConclusionsDiafiltration predominantly contributed to CLCHDFof VCM using AN69ST and PMMA membranes. When diafiltration rather than adsorption mainly contributes to the CLCHDFof VCM, the CLCHDFcould be predicted from the Qe and HSA concentration, at least in vitro.