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https://doi.org/10.14300/mnnc.2020.15016

Vancomycin clearance calculation according to the mathematical modeling and pharmacokinetic research

[Clinical Pharmacology] [Pharmacology]
Maria Vladimirovna Lukina; Tatiana Evgenyevna Morozova; Tatyana Borisovna Andrushchishina; Maria Alexandrovna Chukina; Galina Vladislavovna Ramenskaya; Igor Evgenievich Shokhin;

For comparing the results of calculating the vancomycin clearance (Cl_van) by various methods in patients after surgery with acute kidney injury (AKI). A prospective observational study was conducted in the University Clinical Hospital № 1. Objects were 61 patients with infectious complications after surgery. Patients were divided into 2 groups: 1st – patients with signs of acute kidney injury (AKI) (n=35, 66.6 %), 2nd – without AKI (n=26, 33.4 %). Cl_van was calculated by different calculation methods: DeRyke, Pea, Moise –Broder, «ClinCalс», as well as actual concentrations obtained during pharmacokinetic study (PS). In AKI group Cl_van values were 40.90±15.6 ml/min according to DeRyke, 41.79±10.3 ml/min, by Pea – 41.79±10.3 ml/min, by Moise – Broder – 58.49±16.6 ml/min, by ClinCalс – 48.53±22.12 ml/min, by TLM – 119.28±48.31 ml/min; in patients without AKI – 57.58±8.11; 52.45±5.19; 76.05±8.54; 63.29±19.28; 84.37±27.63 ml/min, respectively. Cl_van values did not significantly differ being calculated by DeRyke and Pea methods (p=0.259). The remaining mean Cl_van values differed significantly, Cl_van values were significantly higher than the DeRyke values (p<0.001), Pea (p<0.001), Moise – Broder (p<0.001), ClinCalс (p<0.001). In AKI group, the relative error in the calculation accuracy Cl_van according DeRyke, Pea, Moise – Broder, ClinCalс formulas was 60 %, 56 %, 43 %, 58 %, respectively; in the group without the AKI, the relative error in the calculation accuracy Cl_van was 37 %, 49 %, 35 %, 47 %, respectively. The results of our study indicate that the use of different methods for calculating and predicting Cl_van values based on calculated values of creatinine clearance is unjustified.

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Keywords: vancomycin clearance, pharmacokinetic study, mathematical modeling, creatinine clearance