终末期肾病肾脏替代治疗患者万古霉素用药及治疗药物监测现状分析

Analysis of vancomycin administration and therapy drug monitoring status in patients with end-stage renal disease treated with renal replacement therapy

目的:调查终末期肾病患者万古霉素用药及治疗药物监测数据,为规范此类特殊人群万古霉素合理用药提供数据支持。方法:回顾性分析2014年4月至2021年2月中国医科大学附属盛京医院终末期肾病患者万古霉素治疗药物监测病例,调查患者基本情况、肾脏替代治疗、万古霉素用药及治疗药物监测,分析不同肾脏替代治疗万古霉素用药及治疗药物监测状况。结果:纳入患者51例,32例(62.7%)采用血液透析,腹膜透析13例(25.5%),连续肾脏替代治疗6例(11.8%)。所有患者均采用固定剂量的给药模式,均未给予负荷剂量,给药频次和给药时机存在差异。监测时机合理率仅27.5%,49.1%患者住院期间仅监测1次。血液透析初次监测时机把控较为严格,腹膜透析及连续肾脏替代治疗监测时机随意性较大。所有51例患者共进行监测101例次,其中93例次为谷浓度,谷浓度<10 mg·L^(-1)为31例(33.3%),10~20 mg·L^(-1)为40例(43.0%),>20 mg·L^(-1)为22例(23.7%)。依据监测结果,用药剂量或频次调整比例分别为23.9%,20.0%,45.5%。万古霉素谷浓度达标率由27.5%升至96.1%。结论:终末期肾病万古霉素用药应采取标准的负荷剂量和个体化维持剂量,配合治疗药物监测可提高治疗达标率。

OBJECTIVE To investigate the data of vancomycin usage and therapeutic drug monitoring in patients with end-stage renal disease, and provide data support for standardizing the rational use of vancomycin in this special population.METHODS From April 2014 to February 2021, the monitoring cases of vancomycin in patients with end-stage renal disease in Shengjing Hospital Affiliated to China Medical University were retrospectively analyzed. The characteristics of patients, renal replacement therapy, vancomycin usage and drug monitoring were investigated, and the status of vancomycin usage and drug monitoring in different renal replacement therapy was analyzed.RESULTS Among 51 patients, 32(62.7%) received hemodialysis, 13(25.5%) received peritoneal dialysis and 6(11.8%) received continuous renal replacement therapy. All the patients were prescribed a fixed dose mode and no loading dose. The frequency and timing of medication were different. The reasonable rate of monitoring opportunity was only 27.5%, and 49.1% of patients were monitored only once during hospitalization. The timing of initial monitoring of hemodialysis was strict, while that of peritoneal dialysis and continuous renal replacement therapy was random. All the 51 patients were monitored for 101 times, of which 93 times were for trough concentration. Totally 31 cases(33.3%) were with trough concentration below 10 mg·L^(-1), 40 cases(43.0%) were with trough concentration between 10 mg·L^(-1)and 20 mg·L^(-1), and 22 cases(23.7%) were with trough concentration above 20 mg·L^(-1). According to the monitoring results, the adjustment ratio of dosage or frequency was 23.9%, 20.0% and 45.5%, respectively. The achievement rate of vancomycin trough concentration increased from 27.5% to 96.1%.CONCLUSION The standard loading dose and individualized maintenance dose should be adopted for vancomycin medication in end-stage renal disease, and the therapeutic drug monitoring can improve the therapeutic compliance rate.