International Journal of Clinical Pharmacy

, Volume 39, Issue 1, pp 37–40 | Cite as

Evaluation of nucleoside reverse transcriptase inhibitor dosing during continuous veno-venous hemofiltration

  • Milena M. McLaughlin
  • Inela Masic
  • Lana Gerzenshtein
Short Research Report


Background Unpredictable drug concentrations may lead to suboptimal exposure to nucleoside reverse transcriptase inhibitors (NRTIs) due to inadequate doses administered during continuous veno-venous hemofiltration (CVVH), which in turn may lead to decreased antiretroviral efficacy and possibly further HIV disease progression. Objective To compare administered doses of NRTIs to calculated doses of NRTIs to evaluate if patients were expected to have a favorable pharmacokinetic exposure profile while receiving CVVH. Methods The NRTI dose was compared to a table of recommendations based on a mathematical formula that estimates the amount of drug expected to be removed during CVVH. Results Twelve patients were on 27 NRTIs. Eleven (41%) NRTI doses were expected to provide a favorable pharmacokinetic profile based on pharmacokinetic mathematical calculations. Conclusion The majority of NRTIs were potentially not optimally dosed based on proposed pharmacokinetic calculations.


Continuous veno-vous hemofiltration HIV Nucleoside reverse transcriptase inhibitor Pharmacokinetics NRTIs 



This study was funded in part by a student research grant from Midwestern University Chicago College of Pharmacy, Downers Grove, IL.

Conflicts of interest

Milena M. McLaughlin, Inela Masic, Lana Gerzenshtein declare that they have no conflicts of interest.


  1. 1.
    Calza L. Renal toxicity associated with antiretroviral therapy. HIV Clin Trials. 2012;13:189–211.CrossRefPubMedGoogle Scholar
  2. 2.
    Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, et al. Continuous renal replacement therapy: a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B.E.S.T. kidney) investigators. Intensive Care Med. 2007;33:1563–70.CrossRefPubMedGoogle Scholar
  3. 3.
    Forni LG, Hilton PJ. Continuous hemofiltration in the treatment of acute renal failure. N Engl J Med. 1997;336:1303–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Gupta SK, Eustace JA, Winston JA, Boydstun II, Ahuja TS, Rodriguez RA, et al. Guidelines for the management of chronic kidney disease in HIV-infected patients: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2005;40:1559–85.CrossRefPubMedGoogle Scholar
  5. 5.
    Fabbiani M, Di Giambenedetto S, Bracciale L, Bacarelli A, Ragazzoni E, Cauda R, et al. Pharmacokinetic variability of antiretroviral drugs and correlation with virological outcome: 2 years of experience in routine clinical practice. J Antimicrob Chemother. 2009;64:109–17.CrossRefPubMedGoogle Scholar
  6. 6.
    Fletcher CV, Anderson PL, Kakuda TN, Schacker TW, Henry K, Gross CR, et al. Concentration-controlled compared with conventional antiretroviral therapy for HIV infection. AIDS. 2002;16:551–60.CrossRefPubMedGoogle Scholar
  7. 7.
    McCabe SM, Ma Q, Slish JC, Catanzaro LM, Sheth N, DiCenzo R, et al. Antiretroviral therapy: pharmacokinetic considerations in patients with renal or hepatic impairment. Clin Pharmacokinet. 2008;47:153–72.CrossRefPubMedGoogle Scholar
  8. 8.
    McLaughlin MM, Ammar AT, Gerzenshtein L, Scarsi KK. Dosing nucleoside reverse transcriptase inhibitors in adults receiving continuous veno-venous hemofiltration. Clin Drug Investig. 2015;35:275–80.CrossRefPubMedGoogle Scholar
  9. 9.
    Golper TA, Marx MA. Drug dosing adjustments during continuous renal replacement therapies. Kidney Int Suppl. 1998;66:S165–8.PubMedGoogle Scholar
  10. 10.
    Prakash J, Gupta T, Prakash S, Rathore SS, Usha, Sunder S. Acute kidney injury in patients with human immunodeficiency virus infection. Indian J Nephrol. 2015;25:86–90.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Panel on antiretroviral guidelines for adults and adolescents. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents. Accessed 27 July 2016.

Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  1. 1.Department of Pharmacy Practice, Chicago College of PharmacyMidwestern UniversityDowners GroveUSA
  2. 2.Northwestern Memorial HospitalChicagoUSA

Personalised recommendations