Drug Dosing in Hemodialysis

Drug-dosing Considerations…

1. Molecular weight/size 

   1. Larger = LESS likely to be removed 

2. Protein binding 

   1. High degree of protein-binding = LESS likey to be removed

3. Volume of Distribution

   1. Larger Vd = LESS likely to be removed 

4. Water solubility 

   1. NOT water soluble = LESS likely to be removed

Small size, NON-protein bound, small Vd, water soluble molecules are likely to be removed

HD Prescription 

→ Intermittent/Conventional 

• 3-4 sessions per week 

• Daytime 

→ Frequent

• 5-7 sessions per week 

• Daytime or nighttime depending on duration 

→ Long 

• Duration at least 5 hours 

• Daytime or nighttime depending on duration 

BFR: Standard, low flow < 300 mL/min

DFR: Standard, low flow < 500 mL/min

HD Filters…

1. Conventional - small pores 

2. High efficiency - larger surface area, large or small pores 

3. High Flux - Larger pores, increased middle molecule clearance 

   1. Remove lots of medication with high flux filter

Intradialytic Hypotension…

 avoid peaking drug concentration during HD

• Pick anti-hypertensives that WILL BE REMOVED by HD

  • Losartan, Carvedilol, Furosemide ARE NOT REMOVED BY HD (dont pick)

  • Most ACEis are removed except fosinopril