Removal of linezolid by conventional intermittent hemodialysis, sustained low-efficiency dialysis, or continuous venovenous hemofiltration in patients with acute renal failure

Crit Care Med. 2004 Dec;32(12):2437-42. doi: 10.1097/01.ccm.0000147687.06808.92.


Objective: To study the removal of linezolid, a new oxazolidinone antibiotic, by renal replacement therapy in patients with acute renal failure.

Design: Prospective, single-dose pharmacokinetic study.

Setting: Renal intensive care unit of a tertiary university hospital.

Patients: Fifteen critically ill patients with oliguric acute renal failure on renal replacement therapy (seven males, mean age 72.3 yrs, range 60-94; Acute Physiology and Chronic Health Evaluation II score 24.9, range 18-36; mechanical ventilation ten of 15).

Interventions: All patients received 600 mg of intravenous linezolid before starting renal replacement therapy, which consisted of intermittent hemodialysis lasting 3-4 hrs in eight patients, sustained low-efficiency dialysis lasting 8 hrs in five patients, and continuous venovenous hemofiltration lasting 10.5-12 hrs in two patients.

Measurements and main results: Linezolid concentrations were measured by liquid chromatography/mass spectrometry methods on serum and dialysate/ultrafiltrate samples. At the start of renal replacement therapy, serum levels averaged 11.91 mg/L (range 5.49-21.52) and dropped at the end to levels <4 mg/dL (90% minimum inhibitory concentration values for Staphylococcus aureus) in three of eight patients on hemodialysis, three of five patients on sustained low-efficiency dialysis, and two of two patients on continuous venovenous hemofiltration. Mean removal of the drug was 193.7 mg with hemodialysis (32.3% of the dose administered), 205 mg with sustained low-efficiency dialysis (33.9%), and 74.8 mg (12.4%) and 105 (17.5%) mg following a continuous venovenous hemofiltration session lasting 10.5 and 12 hrs, respectively.

Conclusions: In patients with acute renal failure, serum levels of linezolid can be reduced to the subtherapeutic range following renal replacement therapy.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetamides / administration & dosage
  • Acetamides / blood
  • Acetamides / pharmacokinetics*
  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / mortality
  • Acute Kidney Injury / therapy*
  • Aged
  • Aged, 80 and over
  • Chromatography, High Pressure Liquid
  • Critical Care / methods
  • Dialysis / methods*
  • Female
  • Follow-Up Studies
  • Hemofiltration / methods*
  • Humans
  • Injections, Intravenous
  • Intensive Care Units
  • Linezolid
  • Male
  • Middle Aged
  • Oxazolidinones / administration & dosage
  • Oxazolidinones / blood
  • Oxazolidinones / pharmacokinetics*
  • Prospective Studies
  • Renal Dialysis / methods*
  • Risk Assessment
  • Severity of Illness Index


  • Acetamides
  • Oxazolidinones
  • Linezolid