Effective clearance of Ara-U the major metabolite of cytosine arabinoside (Ara-C) by hemodialysis in a patient with lymphoma and end-stage renal failure

Cancer Chemother Pharmacol. 2011 Apr;67(4):765-8. doi: 10.1007/s00280-010-1373-2. Epub 2010 Jun 8.


Purpose: We report that hemodialysis clears Ara-U from the blood after high-dose Ara-C treatment in a patient with lymphoma and end-stage renal failure.

Methods: The patient received two doses of Ara-C 1 g/m(2) 24 h apart and was hemodialyzed at about 6 h after each dose and subsequently as per her usual dialysis schedule. Multiple blood samples were collected after dosing. Blood and dialyzate were also collected from the dialysis circuit during a second identical treatment cycle. Ara-C and its metabolite Ara-U in plasma and dialyzate were measured chromatographically, and the data subjected to pharmacokinetic analysis.

Results: The distribution and elimination half-lives, steady-state volume of distribution and clearance values were 0.5 h, 7 h, 181 L and 307 l/h for Ara-C and 4.1 h, 34 h, 118 L and 2.64 l/h for Ara-U, respectively. The dialysis sessions immediately after the first and second doses cleared 39 and 52% (as Ara-U) of the respective Ara-C doses. Some 63% of Ara-U in plasma was extracted by dialysis. The patient showed no signs of neurotoxicity or other drug-related adverse effects.

Conclusion: Hemodialysis is very effective in clearing Ara-U from the plasma in renal failure, and this maneuver could easily be used routinely to prevent Ara-U accumulation and minimize adverse effects in patients with renal failure.

Publication types

  • Case Reports

MeSH terms

  • Antimetabolites, Antineoplastic / adverse effects
  • Antimetabolites, Antineoplastic / metabolism
  • Antimetabolites, Antineoplastic / therapeutic use
  • Arabinofuranosyluracil / adverse effects
  • Arabinofuranosyluracil / blood*
  • Chromatography, High Pressure Liquid
  • Cytarabine / adverse effects
  • Cytarabine / metabolism*
  • Cytarabine / pharmacokinetics
  • Cytarabine / therapeutic use
  • Female
  • Humans
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / therapy*
  • Lymphoma, Mantle-Cell / complications
  • Lymphoma, Mantle-Cell / drug therapy*
  • Middle Aged
  • Neurotoxicity Syndromes / etiology
  • Neurotoxicity Syndromes / prevention & control
  • Renal Dialysis*


  • Antimetabolites, Antineoplastic
  • Cytarabine
  • Arabinofuranosyluracil