Pharmacokinetics of Cis-Diammine-Dichlor-Platin in a Hemodialysis Patient

Abstract

Cisplatin (CDDP) was administered to a 49-year-old dialysis female patient with advanced uterine cervical cancer. Analysis of the pharmacokinetics of CDDP in the patient with renal failure and at hemodialysis were compared with that of patients without renal impairment. CDDP at 30 mg was administered by drip infusion. The samples were ultrafiltrated and measured its concentration of both free (F-P) and total CDDP (T-P) by atomic absorption method. The effect of hemodialysis on the concentration of CDDP was analyzed. For the control, three patients without renal impairment were administered CDDP using the same method and its concentration was measured. The T-P clearance registered no difference between dialysis patients and controls, but F-P clearance in the HD patient was almost 5-fold lower than those in control patients, showing that F-P exposure to HD patients was 5-fold greater as a consequence of delayed disposition. The protein binding rate of CDDP was more gradual than that of the controls. The T-P and F-P removal rates positively correlated to the shunt side blood F-P.

Pharmacokinetically guided dosing of carboplatin and etoposide during peritoneal dialysis and haemodialysis

“…Cisplatin has also been used to treat patients with renal failure on haemodialysis (Fox et al, 1991;Ribrag et al, 1993;Tanabe et al, 1994 (Tanabe et al, 1994). The active agent for both cisplatin and carboplatin is the free platinum drug that is hydrolysed before it binds to DNA or protein.…”

“…Cisplatin is hydrolysed 10-20 times faster than carboplatin and the main route of clearance of free cisplatin is by binding to macromolecules. In spite of this, when renal function deteriorates the plasma clearance of free platinum drops (Reece et al, 1986), and in one anephric patient the plasma clearance of free platinum was five times lower than in individuals with normal renal function (Tanabe et al, 1994). Thus, adaptive control of cisplatin can be used in patients with renal failure.…”

Cisplatin pharmacokinetics in a child receiving peritoneal dialysis

“…Based on the knowledge that between 25-45% of the administered platinum is eliminated in the urine within 5 days of administration [6,7], cisplatin dosing guidelines recommend a 50% reduction in dose when prescribed in the setting of severe renal failure. With the exception of a few case reports describing the administration of cisplatin during hemodialysis (HD) in adults [8][9][10][11][12][13], there is no information available to guide cisplatin therapy during peritoneal dialysis (PD) or continuous renal replacement therapies, or in children with chronic kidney disease. The challenge of designing an appropriate dosing regimen in children receiving dialysis is further complicated by the fact that cisplatin disposition in children with normal kidney function [14,15] may differ from the profile observed in adults.…”

Successful Treatment of Mediastinal Seminoma in a Hemodialysis Patient

“…Table 1A summarizes the experience in treating hemodialyzed patients with either cisplatin or carboplatin [11][12][13][14][15][16][17][18][19][20]. Cisplatin is mainly eliminated through the kidney (90%).…”