Dataset Information

The Impact of Continuous Veno-Venous Hemodiafiltration on the Efficacy of Administration of Prophylactic Doses of Enoxaparin: A Prospective Observational Study.

ABSTRACT:

Background

Critically ill patients frequently require continuous renal replacement therapy (CRRT). During CRRT, particles up to 10 kDa in size, such as enoxaparin, may be removed. The aim of this study was to determine if patients receiving prophylactic doses of enoxaparin and treated with continuous veno-venous hemodiafiltration (CVVHDF) reach prophylactic values of anti-Xa factor activity.

Methods

In this observational trial, we compared two groups: 20 patients treated with CVVHDF and 20 patients not treated with CVVHDF. All of them received prophylactic doses of 40 mg of enoxaparin subcutaneously. Anti-Xa factor activity was determined on the third day of receiving a prophylactic dose of enoxaparin. The first blood sample was taken just before the administration of enoxaparin, and other samples were taken 3 h, 6 h, and 9 h after the administration of a prophylactic dose of enoxaparin.

Results

At 3 and 6 h after administration of enoxaparin in both groups, we observed a significant increase in anti-Xa factor activity from baseline, with the peak after 3 h of administration. There were no significant differences in the numbers of patients who had anti-Xa factor activity within the prophylactic range between CVVHDF and control groups.

Conclusion

CVVHDF has only a mild effect on the enoxaparin prophylactic effect measured by anti-Xa factor activity. Thus, it seems there is no need to increase the dose of enoxaparin for patients requiring CVVHDF.

SUBMITTER: Aszkielowicz A

PROVIDER: S-EPMC10457944 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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Publications

The Impact of Continuous Veno-Venous Hemodiafiltration on the Efficacy of Administration of Prophylactic Doses of Enoxaparin: A Prospective Observational Study.

Aszkiełowicz Aleksander A Steckiewicz Karol P KP Okrągły Michał M Wujtewicz Magdalena A MA Owczuk Radosław R

Pharmaceuticals (Basel, Switzerland) 20230816 8

<h4>Background</h4>Critically ill patients frequently require continuous renal replacement therapy (CRRT). During CRRT, particles up to 10 kDa in size, such as enoxaparin, may be removed. The aim of this study was to determine if patients receiving prophylactic doses of enoxaparin and treated with continuous veno-venous hemodiafiltration (CVVHDF) reach prophylactic values of anti-Xa factor activity.<h4>Methods</h4>In this observational trial, we compared two groups: 20 patients treated with CVVH ...[more]

PMID: 37631081

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Project description:BackgroundMyoglobin clearance in acute kidney injury requiring renal replacement therapy is important because myoglobin has direct renal toxic effects. Clinical data comparing different modalities of renal replacement therapy addressing myoglobin clearance are limited. This study aimed to compare two renal replacement modalities regarding myoglobin clearance.MethodsIn this prospective, randomized, single-blinded, single-center trial, 70 critically ill patients requiring renal replacement therapy were randomized 1:1 into an intervention arm using continuous veno-venous hemodialysis with high cutoff dialyzer and a control arm using continuous veno-venous hemodiafiltration postdilution with high-flux dialyzer. Regional citrate anticoagulation was used in both groups to maintain the extracorporeal circuit. The concentrations of myoglobin, urea, creatinine, β2-microglobulin, interleukin-6 and albumin were measured before and after the dialyzer at 1 h, 6 h, 12 h, 24 h and 48 h after initiating continuous renal replacement therapy.ResultsThirty-three patients were allocated to the control arm (CVVHDF with high-flux dialyzer) and 35 patients to the intervention arm (CVVHD with high cutoff dialyzer). Myoglobin clearance, as a primary endpoint, was significantly better in the intervention arm than in the control arm throughout the whole study period. The clearance values for urea and creatinine were higher in the control arm. There was no measurable albumin clearance in both arms. The clearance data for β2-microglobulin and interleukin-6 were non-inferior in the intervention arm compared to those for the control arm. Dialyzer lifespan was 57.0 [38.0, 72.0] hours in the control arm and 70.0 [56.75, 72.0] hours in the intervention arm (p = 0.029).ConclusionsMyoglobin clearance using continuous veno-venous hemodialysis with high cutoff dialyzer and regional citrate anticoagulation is better than that with continuous veno-venous hemodiafiltration with regional citrate anticoagulation.Trial registrationGerman Clinical Trials Registry (DRKS00012407); date of registration 23/05/2017. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012407 .

Project description:ObjectiveThe aim of this study is to establish a population pharmacokinetic (PK) model for patients undergoing continuous veno-venous hemodiafiltration (CVVHDF) and optimize the dosing regimen of colistin sulfate.MethodsA prospective observational study in a single center was conducted on patients who were administrated with colistin sulfate and CVVHDF for at least 48 h. Blood samples were obtained prior to dosing and four to six blood samples (primarily C0.5h, C1h, C2h, C4h, and C6h) after dosing. The blood concentration of colistin sulfate was determined by ultra-high performance liquid chromatography-tandem mass spectrometry assay. The NONMEM program was used to establish the population PK model and perform Monte Carlo simulations. The predictability and stability of the model were internally evaluated by the goodness of fit plots, visual prediction check, and bootstraps.ResultsA total of 86 plasma concentrations from 20 patients were used for population PK modeling. A two-compartment model with first-order linear elimination best described the population PK characteristics of colistin sulfate. Cystatin C (CysC) and body weight (WT) were identified as covariates for clearance (CL). Internal evaluation results showed that the final model had good stability and prediction performance. Monte Carlo simulations showed that only when the body WT was 50 kg with CysC ≥3.07 mg/l, and when the body WT was 65 kg with CysC = 5.11 mg/l, and minimum inhibitory concentration (MIC) = 0.25 mg/l, the target attainment probability (PTA) of the daily dose of 1.5 million U regimen was ≥90%. All treatment regimens fail to achieve the target PTA when MIC = 1 mg/l.ConclusionsWith the decrease of CysC levels and the increase of WT, the dose of colistin sulfate may need to be increased. It may be prudent for colistin sulfate to consider an initial dose doubling and subsequent maintenance dosing regimen of 200-225 million unit daily, administered in 2-3 divided doses, to attain PTA standard. This study was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn) (trial registration number ChiCTR2300072191).

Dataset Information

The Impact of Continuous Veno-Venous Hemodiafiltration on the Efficacy of Administration of Prophylactic Doses of Enoxaparin: A Prospective Observational Study.

Background

Methods

Results

Conclusion

Publications

The Impact of Continuous Veno-Venous Hemodiafiltration on the Efficacy of Administration of Prophylactic Doses of Enoxaparin: A Prospective Observational Study.

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