Welcome to DialyzePDΒΆ

Dialyzability and Dosing of Medications in Patients Undergoing Peritoneal Dialysis

Disclaimer

This website is intended only to serve as an informational tool summarizing existing data from the literature and is not intended to replace clinical judgment of healthcare professionals.

Background

Despite ongoing research, drug dosing in end-stage renal disease (ESRD) patients receiving dialysis therapy remains a challenge to many healthcare providers. In 2011, a Lower Mainland Pharmacy Services resident had undertaken a project to review the dialyzability of drugs in patients receiving intermittent hemodialysis (http://www.dialyzeihd.com). We wish to extend this work further and investigate the dialyzability of drugs in patients receiving peritoneal dialysis (PD). When adjusting medication dosages for PD patients, one must consider the type of peritoneal dialysis, the magnitude of the dose, the timing of administration with regard to the dialysis schedule, and the potential need for supplemental dosing. Data from the literature, when combined with the pharmacokinetic attributes of a drug such as molecular size, protein binding, volume of distribution, water solubility, and intrinsic clearance, may be used to assess the extent to which a drug may be removed by peritoneal dialysis, such that a safe yet effective dose may be recommended for the patient. An easily accessible point-of-care medication dosing tool would be highly valuable, as such a tool is believed to improve workflow and optimize patient care.

Methods

MEDLINE, EMBASE, and International Pharmaceutical Abstracts were searched for dosing and pharmacokinetic studies of drug clearance with respect to the use of selected medications in peritoneal dialysis patients. Identified articles were examined for dosing and pharmacokinetic properties in ESRD. Relevant references identified from the reference lists of review articles were also retrieved and reviewed. Dialysis modality search terms were: Peritoneal dialysis (continuous ambulatory peritoneal dialysis, automated peritoneal dialysis). Limitations place on the literature search were: English, Human, Adult.

Results

Guidelines, pharmacokinetic studies, case reports, clinical trials and review articles were identified and reviewed through a systematic literature search for approximately 60 drugs from various drug classes: antidepressants, antipsychotics, antiretrovirals, antivirals, antibiotics, and antifungals. Pharmacokinetic parameters such as molecular weight, plasma protein binding, volume of distribution, renal excretion and half-lives were extracted from _____. Relevant clinical case reports or trials have also been summarized on each drug detail page to support dosing decisions for practitioners.

Definitions

  • CAPD
    • [definition here]
  • CCPD
    • [definition here]
  • APD
    • [definition here]

Medication Management in PD Patients: Dr Clifford Lo & Claudia Ho

Presenters: Claudia Ho, ACPR; Clifford Lo, PharmD

Prepared by: Jane Lin, PharmD; Robin Cho, PharmD and Jeff Jeong B.sc. (Pharm)

Acknowledgements: Marianna Leung, PharmD; Chen Shen, PharmD; Viktor Kalashnikov, B.Sc. (Pharm); Jon Wiesendahl, B.Sc. (Pharm); Ava Azhir, B.Sc. (Pharm)