Details

Autor(en) / Beteiligte

• Collignon, Charlotte
• de Marcellus, Charles
• Oualha, Mehdi
• Neuranter, Valentin
• Heilbronner, Claire
• Hirt, Déborah

Titel

Pharmacokinetic profile of acyclovir in a child receiving continuous kidney replacement therapy for acute liver failure

Ist Teil von

• Pediatric nephrology (Berlin, West), 2023-10, Vol.38 (10), p.3493-3497

Ort / Verlag

Berlin/Heidelberg: Springer Berlin Heidelberg

Erscheinungsjahr

2023

Quelle

SpringerLink

Beschreibungen/Notizen

• Background Continuous venovenous hemodiafiltration (CVVHDF) is one of the treatments of critically ill children presenting severe acute liver failure. This affliction might be induced by HSV infection requiring a treatment by acyclovir. Continuous kidney replacement therapy (CKRT) can alter its pharmacokinetics, according to its physicochemical properties and CVVHDF settings. Case–Diagnosis/Treatment The patient was a 21-month-old female presenting liver failure with hyperammonemia treated by acyclovir with presumed HSV infection. CKRT was initiated on day 1 with substantial replacement and dialysate flow rates (respectively 75 and 220 mL/kg/h). Acyclovir was intravenously administered every 8 h with a 1-h infusion of 500 mg/m 2 . Plasma and effluent concentrations were measured by liquid chromatography-tandem mass spectrometry assay to estimate the area under a curve (AUC) and CKRT clearance by 2 methods (one based on pre- and post-filter concentrations and the other one on dialysate flow rates). Clearance was estimated between 19.2 and 26.3 mL/min with the first method and between 27.6 and 44.3 mL/min with the second one. Concentrations were highly above the therapeutic index (peak concentration was measured at 28 mg/L), but AUC was appropriate. Conclusions This case describes acyclovir pharmacokinetics during CKRT in a pediatric patient treated by acyclovir. The patient was treated with adapted exposure with the usual dosing, but lower dosing should be investigated with complementary studies. Trial registration ClinicalTrials.gov NCT02539407.