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Oral presentation

There are today close to one million people with end stage renal failure (ESRF) worldwide on maintenance dialysis. Most of them are elderly with many comorbidities requiring wide spectrum of medication. Regular intermittent dialysis may significantly influence drug levels and usual dosage has thus to be adjusted in those patients.

Currently used extracorporeal blood cleansing methods in ESRF include purely diffusive technique (conventional low-flux haemodialysis – HD) as well as techniques with augmented or sole convective transport component (high-flux haemodialysis – HFHD, haemodiafiltration – HDF, haemofiltration – HF).

To assess possible drug removal by the above methods certain drug-related parameters describing its dialysability have to be evaluated prior to the drug release for the market and those data then included in the Instructions for use. Those data include molecular weight, electric charge of the drug molecule, protein binding and clearance and sieving coefficient values for specified dialyser membrane and dialysis conditions. Procedures to measure those parameters are specified in the EN 1283 norm on haemodialysers, haemodiafilters and haemofilters. The nephrologist has to combine those data with performance data of the dialyser and dialysis procedure parameters (extracorporeal blood flow, ultrafiltration and substitution rate, session time), which he intends to use in a particular patient to assess drug removal by dialysis and make appropriate changes in drug dosage and application schedule. The paper elucidates physical principles of the above blood cleansing methods and its relevant parameters as well as the drug parameters to be measured.

References

1. Hudson JQ, Comstock TJ, Feldman GM: Evaluation of an in vitro dialysis systém to predict drug removal.

   Nephrol. Dial. Transpl 2004, 19:400-405. Publisher Full Text

2. Standard EN 1283 European: .

   Haemodialysers, haemodiafilters, haemofilters, haemoconcentrators and their extracorporeal circuits CEN 1996.

3. Meyer B, Ahmed el Gendy S, Delle Karth G, Locker GJ, Heinz G, Jaeger W, Thalhammer F: How to calculate clearance of highly protein-bound drugs during continuous venovenous hemofiltration demonstrated with flucloxacillin.

   Kidney Blood Press Res 2003, 26:135-140. PubMed Abstract | Publisher Full Text

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