Effect of Renal Failure and Hemodialysis on Aminocaproic Acid Plasma Concentrations

High Anion Gap Metabolic Acidosis Associated with Aminocaproic Acid

“…7 Decreased clearance of ACA has been documented in patients with renal failure based on measured ACA plasma concentrations. 8,9 ACA does not bind significantly to plasma proteins, 10 and two reports 8, 9 provide the only published data indicating ACA is removed by both peritoneal dialysis and hemodialysis. An estimated 53% increase in overall clearance resulted from hemodialysis in one reported case.…”

“…An estimated 53% increase in overall clearance resulted from hemodialysis in one reported case. 9 While decreased clearance of ACA in patients with renal failure is acknowledged in standard information sources, no dosage guidelines are suggested. 2, 3 In the absence of firm dosage guidelines, the maintenance dose used in this case was one-half of the 1-g/h dose rate shown to produce adequate systemic fibrinolysis with estimated ACA plasma concentrations of 130 µg/mL.…”

“…Presently, the limited data correlating ACA plasma concentrations to hemostatic effect and for on-dialysis and off-dialysis ACA clearance do not allow firm dosing recommendations for use in renal failure. Haug et al 9 advocated a maintenance dose of 15-25% of the usual 1 g/h dose (150 -250 mg/h). Furthermore, as those authors reported an improved total ACA clearance by about 50% during hemodialysis, ACA dosing during dialysis might need to be increased by a factor of 1.5 to preserve drug efficacy.…”