Effect of continuous venovenous hemodialysis on outcome and pharmacokinetics of arsenic species in a patient with acute promyelocytic leukemia and acute kidney injury

Abstract

This study presented outcome and pharmacokinetics of arsenic trioxide (ATO) metabolites in patients on continuous venovenous hemodialysis (CVVHD). Of three acute promyelocytic leukemia (APL) patients receiving CVVHD in management of acute kidney injury (AKI), only one patient was included. The patient presented disseminated intravascular coagulation (DIC) and AKI before induction therapy was conducted. CVVHD was performed and ATO was initiated. Species of ATO metabolites in plasma and effluent were analyzed using high performance liquid chromatography‐hydride generation‐atomic fluorescence spectrometry. Plasma concentrations of As^III, monomethylarsonic acid (MMA^V) and dimethylarsinic acid (DMA^V) with CVVHD were lower than those without CVVHD. AUC_0‐t of As^III without CVVHD was significantly higher than that with CVVHD (292.10 ng*h/mL versus 195.86 ng*h/mL, P=0.037), which were not observed for MMA^V and DMA^V. Dialysate saturation of arsenic species was remarkable, especially for As^III. Complete remission was achieved and renal function was recovered. In this study, ATO can be used safely and effectively to treat APL patients undergoing CVVHD without dose adjustment.

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