Dosing Recommendations for Continuous Venovenous Hemodiafiltration with AN69 Filter Membranes and Prismaflex Dialyzers
Bibliographic record
Abstract
Background: Continuous renal replacement therapy is used to manage fluid and solute imbalances in critically ill patients but may affect the clearance of concurrently administered drugs. The impact of continuous renal replacement therapy on pharmacokinetics has been summarized, but previous reports have included studies involving various modes of therapy, filter membranes, and brands of dialyzers, which makes it difficult to apply the recommendations to individual patients. In Canada, continuous venovenous hemodiafiltration (CVVHDF) with a Prismaflex dialyzer machine (Gambro, Saint-Léonard, Quebec) and AN69 filter membranes is the most common mode of continuous renal replacement therapy for critically ill patients.Objective: To develop a set of dosage recommendations for commonly encountered medications used in treating critically ill patients who are undergoing CVVHDF with a Prismaflex dialyzer and AN69 filter membranes.Methods: A literature search was conducted to identify studies of the pharmacokinetics and disposition of drugs in patients undergoing CVVHDF via a Prismaflex dialyzer (sold under 3 brand names: Gambro, Hospal, and Prima) equipped with polyacrylonitrile (AN69) filter membranes. From each study, the mean total clearance of each study medication during CVVHDF was extracted and compared with clearance of the drug in patients not undergoing CVVHDF, to produce dosage guidelines for patients undergoing CVVHDF.Results: A total of 22 studies of 14 medications were included in the final review. For most of the drugs, the total clearance during CVVHDF was less than clearance in patients whose renal function was presumed to be normal. Fluconazole and moxifloxacin had greater total clearance during CVVHDF, but a dose adjustment during CVVHDF was deemed necessary only for fluconazole.Conclusions: Dosing recommendations were created for concurrently administered drugs for patients undergoing treatment with this particular CVVHDF equipment. Patient-specific factors and clinical judgement should also be taken into account.RÉSUMÉ Contexte : Le traitement continu de remplacement de la fonction rénale est utilisé pour rétablir l’équilibre hydro-électrolytique chez les patients gravement malades, mais il peut modifier la clairance des médicaments administrés en concomitance. L’effet du traitement continu de remplacement de la fonction rénale sur le comportement pharmacocinétique a fait l’objet de synthèses, mais ces rapports antérieurs ont compilé des études ayant eu recours à divers modes de traitement, membranes filtrantes et marques de dialyseurs, ce qui rend difficile l’application des recommandations à des cas particuliers. L’hémodiafiltration vénoveineuse continue (HDFVV) au moyen du dialyseur Prismaflex (Gambro, Saint-Léonard [Québec]) et de membranes filtrantes AN69 constitue la méthode de remplacement de la fonction rénale la plus courante chez les patients gravement malades au Canada.Objectif : Créer une série de recommandations posologiques pour les médicaments les plus couramment utilisés dans le traitement des patients gravement malades sous HDFVV au moyen du dialyseur Prismaflex et de membranes filtrantes AN69.Méthodes : Une recherche bibliographique a été effectuée pour déterminer les études du comportement pharmacocinétique et du devenir des médicaments chez les patients sous HDFVV au moyen du dialyseur Prismaflex (vendu sous trois noms de marque : Gambro, Hospal et Prisma) muni de membranes filtrantes de polyacrylonitrile (AN69). Pour chacune des études, on a recensé la clairance moyenne totale de chaque médicament à l’étude chez les patients sous HDFVV et on l’a comparée à sa clairance chez les patients qui n’étaient pas sous HDFVV, pour ainsi produire des lignes directrices sur la posologie des médicaments utilisés chez les patients sous HDFVV.Résultats : Au total, 22 études de 14 médicaments ont été incluses dans l’analyse finale. Pour la plupart des médicaments, la clairance totale durant l’HDFVV était inférieure à la clairance chez les patients dont la fonction rénale était supposément normale. Le fluconazole et la moxifloxacine avaient une clairance totale plus importante durant l’HDFVV, mais un ajustement de la dose durant l’HDFVV a été jugé nécessaire seulement pour le fluconazole.Conclusions : Des recommandations posologiques ont été créées pour les médicaments administrés en concomitance avec l’HDFVV effectué avec ce dialyseur particulier. Les facteurs spécifiques au patient et le jugement du clinicien doivent également être pris en compte.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.014 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.005 |
| Bibliometrics | 0.007 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.004 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".