Vancomycin and HDF Version 1.0 25/2/14
Research type
Research Study
Full title
The extraction of vancomycin during haemodiafiltration; validation of a unidimensional mathematical model of combined diffusive and convective solute flux in haemodialysis.
IRAS ID
149369
Contact name
Gerald Robert Glancey
Contact email
Sponsor organisation
Ipswich Hospital NHS Trust
Research summary
Haemodialysis removes waste substances from the blood stream of patients in whom the kidneys have failed. Two forms of haemodialysis are in common use: standard high flux dialysis and haemodiafiltration. Fundamentally similar, they both require the use of a high flux haemodialyser (artificial kidney). The difference is that haemodiafiltration involves filtering extra fluid from the blood beyond that required simply to restore a patient’s fluid balance. The extra fluid removed (typically 15-20 litres per session)is replaced with fresh fluid through the dialysis machine (usually after the haemodialyser) before the blood is returned to the patient. In doing so haemodiafiltration is thought to increase the amount of waste substances (uraemic toxins) that are extracted (removed) but may also increase the extraction of therapeutic agents such as vancomycin as a result of which this antibiotic may need to be administered differently in patients on haemodiafiltration as opposed to other forms of haemodialysis.
There are some studies that appear to show that haemodiafiltration may be better for patients than standard high flux haemodialysis in terms of long term survival. This is still a very hotly disputed topic and one of the missing pieces in the argument as to the reason for any difference is knowledge of the extent to which haemodiafiltration increases the extraction of uraemic toxins as against standard high flux dialysis.
The main purpose of this study is to measure the difference haemodiafiltration makes over standard high flux dialysis to the extraction of vancomycin, folate, phosphate and urea from patients on dialysis in order to use that data to validate a new mathematical model of haemodialysis that can predict the effect of haemodifiltration on the extraction of vancomycin as well as uraemic toxins with molecular weights of up to circa 5kD.
REC name
East of England - Cambridge Central Research Ethics Committee
REC reference
14/EE/0140
Date of REC Opinion
16 May 2014
REC opinion
Favourable Opinion