Background Dialyzability, the extent of drug that is removed in a dialysis session, is primarily determined by the pharmacokinetic properties of the drug, technical aspects of the dialysis procedure, as well as the type of dialyzer membrane. Drug removal during hemodialysis affects drug effectiveness, the administration timing around the dialysis schedule, and the needs for supplemental dosing. However, dialyzability data is often limited and difficult to interpret in the available literature.

Methods A comprehensive literature review of pharmacokinetic studies of drug dialyzability in patients undergoing chronic intermittent hemodialysis was conducted. A total of 186 medications were reviewed utilizing three databases (PubMed, EMBASE, and International Pharmaceutical Abstracts). The dialyzability data, where available, along with the pharmacokinetic parameters of the drugs and clinical experience of the renal pharmacists were used to provide drug dosing recommendations in intermittent hemodialysis.

Results The medications are grouped by drug category. Their dialyzability properties are presented along with recommendations and rationales for adjustments, if any, in dosing and administration timing around the hemodialysis schedule. Where dialyzability data was not available, consensus was drawn from clinicians, tertiary references and drug pharmacokinetic data to produce the dosing recommendations.

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Prepared by Polly Kwok, B. Sc. (Pharm) and Marianna Leung, PharmD

Acknowledgements: Fong Huynh, PharmD; Kevin Chiu, B. Sc. (Pharm); Michael Chan; Gary Peng