1345: SCOPING REVIEW OF BETA-LACTAM DRUG DOSING IN SUSTAINED LOW-EFFICIENCY DIALYSIS

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Introduction: Critically ill patients often require renal replacement therapy (RRT). Sustained low efficiency dialysis (SLED) is a hybrid modality between intermittent hemodialysis and continuous RRT that has gained popularity for its hemodynamic advantages and decreases in cost and nursing demand. As an emerging modality, guidance for drug dosing is limited, however. This review aims to summarize published data on dosing of beta-lactam antibiotics for patients receiving SLED. Methods: PubMed, Embase, and Scopus were searched for adult human studies using terms related to SLED and drug dosing/monitoring or pharmacokinetics. SLED was defined as intermittent dialysis lasting 6-18 hours. Non-original research, non-English, and assessment of quickly titratable drugs were excluded. References were screened using a two-phase, two-reviewer process. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Fourteen of 29 included SLED studies assessed dosing of 8 beta-lactams including cefepime, ceftazidime, penicillin G, piperacillin/tazobactam, ticarcillin/clavulanate, ertapenem, imipenem/cilastatin, and meropenem. All studies occurred in critically ill patients. SLED duration of 8-hours was most common, but blood and dialysate flow rates varied among studies. Meropenem and piperacillin/tazobactam were most frequently studied with recommended doses ranging from 1g every 6-12 hours and 3.375g every 8 hours to 4.5g every 6 hours, respectively. Dosing recommendations for other beta-lactams were indeterminate. Few patients were included in any study (n=2-34) and no consensus was made on dosing outside of the recommendation for therapeutic drug monitoring. Conclusions: There is a dearth of data regarding drug dosing of beta-lactam antibiotics in patients receiving SLED. Additional studies to optimize dosing in these patients are needed, especially in the absence of routinely available beta-lactam therapeutic drug monitoring assays.

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