Raltegravir dose adjustment not required for patients on dialysis

The effect of haemodialysis on raltegravir clearance was evaluated in two anuric end stage renal disease HIV-positive patients.

Predialyzer (C_in) and postdialyzer (C_out) blood samples were collected at the beginning and end of a single 4 h dialysis session and the haemodialysis extraction ratio (ER) was calculated using (C_in – C_out)/C_in. Raltegravir dialysis clearance (CLd) in terms of plasma was calculated using ER x Qp, where Qp is plasma flow through the dialyzer.

At the end of the session, raltegravir concentrations decreased by 68% in patient 1 and by 45% in patient 2. However, ER and CLd were only 5.5% and 9.1 mL/min in patient 1, and 9.5% and 19.1 mL/min in patient 2, respectively.Both patients maintained raltegravir concentrations higher than 15 ng/mL at the end of the dialysis session.

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These results show minimal removal of raltegravir by haemodialysis and dosage adjustments of raltegravir may not be required.

Ref: Molto J et al. Effect of hemodialysis on raltegravir clearance in HIV-infected patients with end stage renal disease.11th PK Workshop, 2010. Abstract 7.