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Free Mycophenolic Acid Should Be Monitored in Renal Transplant Recipients with Hypoalbuminemia
- Source :
- Therapeutic Drug Monitoring. 26:284-286
- Publication Year :
- 2004
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2004.
-
Abstract
- The current approach for therapeutic drug monitoring in renal transplant recipients receiving mycophenolate mofetil (MMF) is measurement of total mycophenolic acid (MPA) concentration. Because MPA is highly bound, during hypoalbuminemia the total concentration no longer reflects the free (pharmacologically active) concentration. The authors investigated what degree of hypoalbuminemia causes a significant change in protein binding and thus percentage free MPA. Forty-two renal transplant recipients were recruited for the study. Free and total concentrations of MPA (predose, and 1, 3, and 6 hours post-MMF dose samples) and plasma albumin concentrations were determined on day 5 posttransplantation. Six-hour area under the concentration-time curve (AUC(0-6)) values were calculated for free and total MPA, and percentage free MPA was determined for each patient. The authors found a significant relationship between low albumin concentrations and increased percentage free MPA (Spearman correlation = -0.54, P0.0001). Receiver operating characteristic (ROC) curve analysis was performed on the albumin versus percentage free MPA data. The cutoff value of albumin determined from the ROC analysis that differentiated normal from elevated percentage free MPA (defined asor = 3%) in this patient population was 31 g/L. At this cutoff value albumin was found to be a good predictor of altered free MPA percentage, with a sensitivity and specificity of 0.75 and 0.80, respectively, and an area under the ROC curve of 0.79. To rationalize MMF dosing regimens in hypoalbuminemic patients (plasma albuminor = 31 g/L), clinicians should consider monitoring the free MPA concentration.
- Subjects :
- Adult
Male
medicine.medical_specialty
Urology
Serum albumin
Mycophenolate
Sensitivity and Specificity
Mycophenolic acid
Pharmacokinetics
medicine
Humans
Pharmacology (medical)
Hypoalbuminemia
Kidney transplantation
Aged
Pharmacology
biology
medicine.diagnostic_test
business.industry
Albumin
Middle Aged
Mycophenolic Acid
medicine.disease
Kidney Transplantation
Surgery
Therapeutic drug monitoring
Area Under Curve
biology.protein
Female
Drug Monitoring
business
Immunosuppressive Agents
Protein Binding
medicine.drug
Subjects
Details
- ISSN :
- 01634356
- Volume :
- 26
- Database :
- OpenAIRE
- Journal :
- Therapeutic Drug Monitoring
- Accession number :
- edsair.doi.dedup.....884c8bae6c88eb0ea9b14d861f66699d