Evaluation of MPA and MPAG removal by continuous venovenous hemodiafiltration and continuous venovenous hemofiltration.

Abstract:

:The study assessed the removal of mycophenolic acid (MPA) and its major glucuronide metabolite (MPAG) during continuous venovenous hemofiltration (CVVHF) and continuous venovenous hemodiafiltration (CVVHDF) in 4 heart transplant recipients treated for at least 6 days with mycophenolate mofetil (MMF) in addition to cyclosporine and corticosteroids. The sieving coefficient ranged from 0.02 to 0.04 for MPA and from 0.15 to 0.33 for MPAG. The clearance of MPAG by CVVHDF or CVVHF ranged from 7.52 mL/min to 19.45 mL/min, and that of MPA was lower than 2.28 mL/min, with no significant difference between the two continuous replacement therapies. Whereas MPA percentage recovered by hour following CVVHDF or CVVHF was negligible, the percentage of MPAG represents up to 12.9% of the administered dose. A relevant decrease in the free fraction of MPA and MPAG was observed after continuous renal replacement therapy (CRRT). These preliminary results demonstrate that MPAG is able to permeate the filter. In light of the alteration in protein binding following CRRT and the competition between MPA and MPAG to albumin site, drug monitoring of MPA and MPAG in patients undergoing CVVHDF or CVVHF may be suggested. Moreover, monitoring of free MPA may be of interest for these patients.

journal_name

Ther Drug Monit

authors

Cussonneau X,Bolon-Larger M,Prunet-Spano C,Bastien O,Boulieu R

doi

10.1097/FTD.0b013e3181633667

subject

Has Abstract

pub_date

2008-02-01 00:00:00

pages

100-2

issue

1

eissn

0163-4356

issn

1536-3694

pii

00007691-200802000-00016

journal_volume

30

pub_type

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