Kidney Week

Abstract: TH-PO0819

Pharmacokinetics and Potential Toxicity of Long-Term Colchicine Use in Patients on Hemodialysis: A Prospective Observational Study

Session Information

• Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

• 1900 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

Authors

• Thammathiwat, Theerachai, Naresuan University Faculty of Medicine, Tha Pho, Phitsanulok, Thailand

Theerachai Thammathiwat, MD, MSc

• Pichitsiri, Watchara, Naresuan University Faculty of Medicine, Tha Pho, Phitsanulok, Thailand

Watchara Pichitsiri

• Patumanond, Jayanton, Naresuan University Faculty of Medicine, Tha Pho, Phitsanulok, Thailand

Jayanton Patumanond

• Kongtal, Noppakloa, Naresuan University Faculty of Medicine, Tha Pho, Phitsanulok, Thailand

Noppakloa Kongtal, MD

• Tangchitthavorngul, Suri, Naresuan University Faculty of Medicine, Tha Pho, Phitsanulok, Thailand

Suri Tangchitthavorngul, MD, MSc

• Wannakittirat, Anyarin, Naresuan University Faculty of Medicine, Tha Pho, Phitsanulok, Thailand

Anyarin Wannakittirat, MD

• Udomkarnjananun, Suwasin, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand

Suwasin Udomkarnjananun, MD

Background

Long-term colchicine therapy for gout treatment and flare prophylaxis in patients with end-stage kidney disease (ESKD) receiving hemodialysis (HD) remains poorly supported by pharmacokinetic evidence. We evaluated the pharmacokinetic (PK) profile and potential toxicity risk.

Methods

We conducted a prospective observational PK study in ESKD patients receiving maintenance HD 2–3 times weekly who had received colchicine for at least 3 months. Blood colchicine concentrations were measured around the HD session, and dialysate concentrations were analyzed separately using LC-MS/MS. Key blood and dialysate pharmacokinetic parameters were summarized. AUC was calculated using the linear trapezoidal method, and terminal half-life by log-linear regression when at least three terminal concentrations were available. Potential toxicity was defined as observed peak blood colchicine ≥3 ng/mL, with ≥5 ng/mL as a secondary threshold.

Results

Among 23 ESKD patients, median colchicine duration was 0.32 years (IQR, 0.28–6.28). Nine patients (39.1%) had observed peak serum colchicine ≥3 ng/mL, and 2 (8.7%) had ≥5 ng/mL. Trough-like concentration ≥3 ng/mL occurred in 1 patient (4.35%), and none had ≥5 ng/mL. Concentrations declined by the third HD session without redosing (Figure 1). Median AUC0–168h was 80.42 ng.h/mL, average concentration was 0.48 ng/mL, and terminal half-life was 82.97 hours. Median dialysate recovery from 12 sessions was 29.17 mcg, representing 4.86% of the weekly dose. Median apparent dialysate clearance was 7.29 L/h, or 121.5 mL/min. No patient developed myopathy, transaminitis, or leukopenia.

Conclusion

Long-term once-weekly low-dose colchicine in selected maintenance HD patients resulted in measurable systemic exposure but limited sustained accumulation and no observed clinical or laboratory toxicity. Dialysate recovery was small, suggesting limited dialytic removal. Once-weekly colchicine may be safe in selected HD patients with monitoring.

Funding

• Government Support – Non-U.S.