CLINICAL USE OF GANCICLOVIR DURING RENAL-FAILURE AND CONTINUOUS HEMODIALYSIS

Objective: Data is scarce concerning ganciclovir, used in CMV-related diseases in transplant patient with renal failure, especially when dialysis is necessary. Design: Prospective trial. Setting: Intensive care unit in a university hospital, and pharmacy laboratory. Patients: pharmacokinetics were obtained in 3 patients undergoing continuous veno-venous hemodialysis (CVVHD) (PAN 69). Interventions: HPLC measurements of plasmatic and ultrafiltrated ganciclovir were determined at 17 times intervals after a 5 mg/kg every 48 h dosage. Results: Peak and trough concentrations were respectively 16.1+/-2.4 and 5.5+/-0.5 mg/l, sieving coefficient 0.75-0.95, and volume of distribution at steady state 0.64+/-0.09 l/kg, half life (beta phase) 18.6+/-1.81 h. No direct toxicity, or CMV-related death occurred. Conclusion: Plasma concentrations were higher than the ID 90. A dosage of 5 mg/kg/48 h of ganciclovir could be used during CVVHD, and ideally adjusted to monitoring of plasma drug levels.