ABSTRACTS from 16th International COnference on ... - CRRT Online

<strong>ABSTRACTS</strong> FROM 17 TH INTERNATIONAL CONFERENCE ON CRRT,
SAN DIEGO, FEB 14-17, 2012
of death in acute renal failure, and early
appropriate antimicrobial therapy is
associated with improved survival.
Dosing depends on estimation of
pharmacokinetic (PK) parameters
(volume of distribution and clearance).
In an IRB-approved study, we
prospectively measured imipenem levels
in patients receiving CVVHD in the
ICU. PK were compared to
anthropomorphic data and CVVHD
prescription. Methods: Inclusion: Adult
patients with acute or chronic renal
failure who were receiving CVVHD in
the ICU. Exclusion: ESLD, pregnancy.
Patient data including age, gender,
current and admission weight, and
CVVHD dose were recorded on case
report forms (CRFs). Sampling: After
the fourth dose of antibiotic during
uninterrupted CRRT, trough, 3 minute
post infusion peak, and second trough
blood and effluent samples were drawn
and immediately stored on ice. Drug
analysis: Free and effluent imipenem
levels were measured by RP-HPLC in
the lab of one of the investigators
(WHF). Data analysis: Imipenem levels
and data <strong>from</strong> CRFs were entered into a
spreadsheet for PK calculations.
Statistical testing was performed using
JMP 9 for Windows. Parameters with a p
value less than .3 in univariate analyses
were included in multivariate linear
regression analyses. Results: Complete
data was available <strong>from</strong> 17 subjects
dialyzed with the NxStage Express (n=6)
or Gambro Prismaflex (n=11). Volume
of distribution (39.9 +/- 9.6L; .35 +/- .11
L/kg) was greater than previously
reported for healthy subjects. Clearance
(total 14 +/- 26 ml/min; extracorporeal
38. +/- 85 ml/min) was similar to that
previously reported for healthy subject.
Univariate analyses suggested a
relationship between filter type and
volume of distribution, which was
confirmed in a multivariate model
(p=.22). Total clearance was predicted
by CVVHD dose (p =.22), but not by
age, gender or severity score.
Discussion: Imipenem is a broadspectrum
beta-lactam that is
bacteriocidal in a time-dependent
fashion. The large volume of distribution
noted in this critically ill population
suggests that patients may be at risk for
underdosing, and the potential role of
drug binding to the dialyzer is intriguing.
The relationship between CVVHD dose
and total clearance is expected. The total
clearance of unbound drug was similar
to healthy subjects, suggesting that doseadjustment
may not be as necessary in
this population as previously thought.
More research is needed.
76. The Relationship Between Thyroid
Hormone And Corrected QT
Interval And QT Dispersion in
Non-diabetic Hemodialysis
Patients
Hyung-Jong Kim, Dong Ho Yabg,
Keuyng Mi Park
Bundang CHA Medical Center, CHA
University
Purpose: Cardiovascular disease and
sudden cardiac death are common in
hemodialysis patients. These cardiac
complications are often associated with
prolong QTc interval (QTc) and QTc
dispersion (QTcd). Also, subclinical
hypothyroidism is associated with the
risk of heart failure, other cardiovascular
events and death. It was reported that
subclinical hypothyroidism can alter
autonomic modulation of heart rate and
cause increased inhomogeneity of
ventricular recovery times. The purpose
of this study was to evaluate the
relationship between thyroid hormone
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