Hemodialysis elimination rates and clearance of gentamicin and tobramycin

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Abstract
The apparent hemodialyzer elimination rate constant and clearance for gentamicin and tobramycin were determined during 100 routine hemodialysis treatments in 49 patients. Three different dialyzers (CDAK 3500, CF 1211, and CF 1511), which vary in membrane composition, surface area, and thickness, were evaluated. The elimination rate constant in each patient was calculated from the slope of the log serum concentration-time curves. Two different elimination rate constants for each patient were derived, one during hemodialysis (KT) and one off hemodialysis (K). The hemodialyzer elimination rate constant (KD) for each dialyzer was calculated as the difference between these two values. The hemodialyzer clearance (Cd) was calculated by multiplying the hemodialyzer elimination rate constant by the volume of distribution of the patient. The KDS of gentamicin and tobramycin by the three dialyzers were significantly different. The gentamicin KD of the CDAK 3500 was lower than the values of the CF 1211 and CF 1511 (0.086 versus 0.123 versus 0.131 h-1, respectively). The Cd of the CDAK 3500 for gentamicin was also significantly lower than that of the CF 1511. Although the CdS of tobramycin for the CF 1211 and CF 1511 were 24 and 43% greater than that for the CDAK 3500, these differences were not statistically significant. The KD and Cd of tobramycin were greater than those of gentamicin for all three dialyzers. These data demonstrate that commonly used hemodialyzers vary markedly with respect to their elimination and clearance characteristics of gentamicin and tobramycin. Clinically, these observations may be helpful in designing the correct dose of gentamicin and tobramycin to achieve maximum drug safety and efficacy in hemodialysis patients.