Acyclovir pharmacokinetics across kidney function, hemodialysis, peritoneal dialysis, and CRRT

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Research model · Abdalla 2020

Pediatric acyclovir: size and kidney function

Explore predicted plasma exposure after repeated IV infusions.

Research only—not for patient dosing. Ages 1–18; no dialysis.

Simulation inputs

Illustrative defaults. Age limits eligibility; weight and eGFR determine clearance.

Plasma acyclovir

Selected eGFR: typical curveSimulated 5th–95th percentilesComparison eGFR: typical curve

Shading shows simulated between-person variability, excluding parameter uncertainty and measurement error.

Concentration table and CSV
Predictions in mg/L; time in hours
TimeTypical5thMedian95thComparison
Weight–eGFR map

How this model works

CL=5.15×(W15)0.75×(eGFR164)0.658L/hCL=5.15\left(\frac{W}{15}\right)^{0.75}\left(\frac{\mathrm{eGFR}}{164}\right)^{0.658}\;\mathrm{L/h}V=16.2×W15LV=16.2\frac{W}{15}\;\mathrm{L}dAdt=Rinf−CLVA\frac{dA}{dt}=R_{\mathrm{inf}}-\frac{CL}{V}AC=AVC=\frac{A}{V}

W: weight (kg); A: drug amount (mg); Rinf: infusion rate (mg/h); C: plasma concentration (mg/L).

Each infusion is solved analytically and added to earlier doses. The orange curve changes eGFR only. Summary peak and trough values represent theoretical steady state; the graph begins with no drug and shows the selected finite course.

Renal-function definition: the paper used historical Schwartz coefficients (0.45 below age 2; 0.55 for ages 2–12 and females 13 or older; 0.7 for males 13 or older), multiplied by height in cm / serum creatinine in mg/dL. Enter that study-defined indexed eGFR directly. Adult Cockcroft–Gault values and absolute mL/min are not interchangeable with this input.

Reproduction assumptions and limits
  • The final Table 2 equations normalize weight to 15 kg; the Methods text says 15.6 kg. This implementation follows Table 2.
  • The variability simulation treats Table 2 values 0.389 and 0.434 as log-scale standard deviations for clearance and volume. Their covariance is not reported; independent effects are assumed. It uses 1,000 virtual individuals and a fixed seed.
  • The study does not establish impaired-renal-function dosing. No extrapolation below eGFR 56, dialysis extension, or neonatal maturation claim is included. Age 1 year is a conservative interface restriction, not a study-derived cutoff.
  • Only the IV component is implemented. Oral dose conventions and formulation effects require a separate reproduction review.
  • Equation and numerical checks are not clinical validation. Individual patient data and the exact simulation covariate distribution were not available; the paper’s population target-attainment percentages and visual predictive checks have not been reproduced.

Source and verification

Compare Abdalla and Zeng models and review the new evidence

Abdalla S et al. Population Pharmacokinetics of Intravenous and Oral Acyclovir and Oral Valacyclovir in Pediatric Population To Optimize Dosing Regimens. Antimicrobial Agents and Chemotherapy. 2020;64:e01426-20. doi:10.1128/AAC.01426-20.

Reproduction notes and verification results