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Article Dans Une Revue Nephron Physiology Année : 2015

A Bayesian Model to Describe Factors Influencing Trough Levels of Vancomycin in Hemodialysis Patients

C. Sansot
  • Fonction : Auteur
E. Kalbacher
  • Fonction : Auteur
Laurent Bourguignon
J. P. Fauvel
  • Fonction : Auteur
M. Ducher
  • Fonction : Auteur

Résumé

BACKGROUND/AIMS: In hemodialysis patients, there is a marked inter-individual variability in the pharmacokinetics of vancomycin. This retrospective study was carried out to design a model describing the parameters that may influence the trough concentrations of vancomycin (TCV) in hemodialysis patients. METHODS: A Bayesian model was constructed from data obtained during 314 hemodialysis sessions performed in 31 hemodialysis patients receiving vancomycin. The model's validity was assessed by goodness of fit. A bootstrap resampling method was used to calculate bias and accuracy for 80 predicted and observed TCV. RESULTS: A total of 31 patients underwent dialysis 3 times a week for a mean duration of 4 h. Their mean age was 69 +/- 12 years. The vancomycin infusion was started 30 min before the scheduled end of the dialysis session at a flow rate of 1,000 mg/h. The mean TCV of the study population was 16.1 +/- 3.2 mg/l. The area under receiver operating characteristic curve of the constructed model was 95.2%. In the validation sample (80 randomly selected TCV), the observed mean TCV was 15.8 +/- 3.6 mg/l, whereas the mean TCV predicted by the model was 15.7 +/- 3.0 mg/l. If the mean bias was low between the predicted and observed TCV (-0.1 mg/l), SD was high (3.43 mg/l). The variables most closely linked to TCV were in descending order: weight after dialysis, weight before dialysis, the dose of vancomycin administered during the previous dialysis session and creatinine concentration before dialysis. CONCLUSION: This simple model describes patient-related and dialysis-related parameters that mainly influence TCV. Before its use in clinical practice, this model should be validated prospectively.
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Dates et versions

hal-01850483 , version 1 (27-07-2018)

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Citer

C. Sansot, E. Kalbacher, Sandrine Lemoine, Laurent Bourguignon, J. P. Fauvel, et al.. A Bayesian Model to Describe Factors Influencing Trough Levels of Vancomycin in Hemodialysis Patients. Nephron Physiology, 2015, 131 (2), pp.131-7. ⟨10.1159/000439230⟩. ⟨hal-01850483⟩
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