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High dose post-HD administration may offer a more convenient outpatient alternative, but supporting data is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the feasibility by assessing predicted pharmacokinetic\/pharmacodynamic (PK\/PD) target attainment and neurotoxicity risk of high-dose post-HD versus daily dosing strategies for cefepime, meropenem, and ceftazidime\/avibactam in patients receiving thrice-weekly IHD, using the Monte Carlo simulation (MCS) techniques.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      One-compartment pharmacokinetic models were developed using published data to simulate drug exposure in anuric patients receiving 4-h IHD thrice-weekly. MCS (Crystal Ball, Oracle) assessed the probability of target attainment (PTA) and neurotoxicity risk of various post-HD and daily dosing regimens in 5,000 virtual cohorts for one week. The PK\/PD targets were\u2009\u2265\u200960%\n                      <jats:italic>f<\/jats:italic>\n                      T\u2009&gt;\u2009MIC for cefepime,\u2009\u2265\u200940%\n                      <jats:italic>f<\/jats:italic>\n                      T\u2009&gt;\u2009MIC for meropenem and\u2009\u2265\u200950%\n                      <jats:italic>f<\/jats:italic>\n                      T\u2009&gt;\u2009MIC for ceftazidime with\u2009\u2265\u200950% fT\u2009&gt;\u20091\u00a0g\/mL for avibactam, assuming\n                      <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                      or\n                      <jats:italic>Enterobactarales<\/jats:italic>\n                      infections. A PTA\u2009\u2265\u200990% was considered optimal for PK\/PD target attainment. Safety was also assessed using the neurotoxicity thresholds.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All daily regimens achieved PTA\u2009\u2265\u200990% on all simulated days. High-dose post-HD cefepime (1\u20132\u00a0g) and meropenem (2\u00a0g) maintained acceptable PTA over 2-day interdialytic periods, but failed to sustain targets through the 3-day period. Ceftazidime\/avibactam post-HD dosing (0.94\u00a0g\u20130.94\u00a0g\u20132.5\u00a0g) maintained\u2009\u2265\u200990% PTA for ceftazidime throughout the week, though avibactam fell slightly below target on the final day. Predicted neurotoxicity risk was negligible for meropenem and ceftazidime\/avibactam, but elevated with higher cefepime doses (1\u20132\u00a0g post-HD and 1\u00a0g daily). Cefepime 0.5\u00a0g daily, meropenem 0.25\u20131\u00a0g daily, and ceftazidime\/avibactam 0.94\u00a0g daily or 0.94\u00a0g\u20130.94\u00a0g\u20132.5\u00a0g post-HD attained both PK\/PD targets and safety targets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>High-dose post-HD dosing appears feasible for ceftazidime\/avibactam but may be inadequate for cefepime and meropenem over a 3-day interdialytic period. Elevated neurotoxicity risk predicted with higher cefepime doses highlights the importance of cautious dosing and consideration of therapeutic drug monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11096-025-02044-5","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T08:09:55Z","timestamp":1764144595000},"page":"636-643","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Evaluation of high dose post-dialytic versus daily beta-lactam dosing in hemodialysis patients using Monte Carlo simulation"],"prefix":"10.1007","volume":"48","author":[{"given":"Andrew J.","family":"Bauman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia G.","family":"Caiazza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nerissa","family":"Wan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sydnee","family":"Payer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia G.","family":"Pauly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sierra","family":"Shoemaker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan J.","family":"Lewis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"2044_CR1","unstructured":"United States Renal Data System. 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