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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Abstract titles should be brief and reflect the content of the abstract.
The International Society for Peritoneal Dialysis (ISPD) recommends intraperitoneal (IP) amikacin 1.5–2 mg/kg daily for PD-related peritonitis, with plasma trough monitoring to reduce toxicity. Routine dialysate monitoring is not advised as levels vary and lack validated targets.1
Asian data show pharmacokinetic variability: Korean² and Chinese³ studies linked amikacin clearance to creatinine clearance, albumin, and illness severity, while Hong Kong⁴ data associated hypoalbuminaemia and resistant infections with poorer outcomes. These findings suggest renal function, nutritional status, and clinical condition influence systemic exposure, supporting population-specific evaluation. Local data from Singapore are limited on whether ISPD dosing achieves safe troughs or which factors drive variability. As such, this study aimed to:
1. Assess whether guideline dosing yields safe troughs in local PD patients, and
2. Identify factors affecting levels.
This retrospective study examined PD-related peritonitis cases managed at Sengkang General Hospital (2018–2023) with ISPD-recommended intraperitoneal amikacin (1.5–2 mg/kg once daily), administered as a single daytime intraperitoneal exchange. All dosing exchanges used glucose-based dialysate with a dwell time of at least six hours, and dosing was adjusted for body weight and BMI.
Collected data included demographics, residual renal function, serum albumin, PD modality (CAPD or APD), Peritoneal Equilibrium Test status, and use of medications such as vancomycin, loop diuretics, or angiotensin receptor blockers (ARB).
Serum trough concentration was measured immediately before the 4th dose. The mean trough was compared against the 5 mg/L safety threshold using a one-sample t-test. Multivariable linear regression assessed associations between patient characteristics and trough levels.
27 peritonitis episodes were included. The median amikacin dose was 100 mg (IQR 90–100), corresponding to 1.66 mg/kg (IQR 1.49–2.0). The mean plasma trough concentration was 7.0 ± 2.6 mg/L, significantly exceeding the 5 mg/L safety threshold (p < 0.001). The median trough was 6.9 mg/L (IQR 5.6–8.6), with 22.2% of episodes ≥5 mg/L and five (18.5%) ≥10 mg/L.
Table 1 showed that although not statistically significant, higher troughs were observed in patients with lower residual renal function, lower albumin, and in high peritoneal transporters. CAPD patients tended to have slightly higher troughs than APD patients. Concomitant vancomycin use was near-universal (96%), limiting comparison; loop diuretics and ARB use were not significantly associated with trough elevation.
Supratherapeutic troughs were frequent despite guideline dosing, reflecting inter-patient pharmacokinetic variability.
In our Singapore PD population, ISPD-recommended intraperitoneal amikacin dosing often produced high plasma trough levels, especially in patients with poor residual renal function or low albumin. Though predictors were not significant, trends matched other Asian cohorts, highlighting renal function, nutrition, and PD modality as key determinants. Early trough checks and possible interval extension may enhance safety; larger studies are needed to refine individualized dosing in Asian PD patients.
