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Drug Therapy in Patients Undergoing Haemodialysis Clinical Pharmacokinetic Considerations

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Summary

Haemodialysis is utilised therapeutically as supportive treatment for end-stage renal disease (ESRD). In conjunction with haemodialysis therapy, ESRD patients frequently receive a large number of drugs to treat a multitude of intercurrent conditions. Because of the impaired renal function in ESRD patients, dosage reduction is often recommended to avoid adverse drug reactions, particularly for drugs and active metabolites with extensive renal excretion. On the other hand, if the removal of a drug by haemodialysis during concomitant drug therapy is significant, a dosage supplement would be required to ensure adequate therapeutic efficacy. Knowledge of the impact of haemodialysis on the elimination of specific drugs is therefore essential to the rational design of the dosage regimen in patients’ undergoing haemodialysis.

This review addresses the clinical pharmacokinetic aspects of drug therapy in haemodialysis patients and considers: (a) the effects of ESRD on the general pharmacokinetics of drugs; (b) dialysis clearance and its impact on drug and metabolite elimination; (c) the definition of dialysability and the criteria for evaluation of drug dialysability; (d) pharmacokinetic parameters which are useful in the prediction of drug dialysability; and (e) the application of pharmacokinetic principles to the adjustment of dosage regimens in haemodialysis patients. Finally, drugs commonly associated with haemodialysis therapy are tabulated with updated pharmacokinetics and dialysability information.

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References

  • Adler, D.S.; Martin, E.; Gambertoglio, J.G.; Tozer, T.N. and Spire, J.P.: Hemodialysis of phenytoin in a urémie patient. Clinical Pharmacology and Therapeutics 18: 65–69 (1975).

    PubMed  CAS  Google Scholar 

  • Alleta, J.M.; Franke, E.F. and Neu, H.C.: Intravenous azlocillin kinetics in patients on long-term hemodialysis. Clinical Pharmacology and Therapeutics 27: 563–566 (1980).

    Article  Google Scholar 

  • Amdisen, A. and Skjoldborg, H.: Haemodialysis for lithium poisoning. Lancet 2: 213 (1969).

    Article  PubMed  CAS  Google Scholar 

  • Andreasen, F.: Protein binding of drugs in serum from patients with acute anuria. Acta Pharmacologica et Toxicologica 29 (Suppl. 4): 2 (1971).

    Google Scholar 

  • Anton. AH. and Corey, W.T.: lnterindividual differences in the protein binding of sulfonamides: The effects of disease and drugs. Acta Pharmacologica et Toxicologica 29 (Suppl. 3): 134–151 (1971).

    PubMed  CAS  Google Scholar 

  • Aronoff, G.R.; Szwed, J.J.; Nelson, R.L.; Marcus, E.L. and Kleit, S.A.: Hypoxanthine-arabinoside pharmacokinetics after adenine arabinoside administration to a patient with renal failure. Antimicrobial Agents and Chemotherapy 18: 212–214 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Avram, M.M. and McGinn, J.T.: Extracorporeal hemodialysis in phenothiazine overdose. Journal of the American Medical Association 197: 142–143 (1966).

    Article  PubMed  CAS  Google Scholar 

  • Bailey, R.R.; Gower, P.E. and Dash, C.H.: The effect of impairment of renal function and haemodialysis on serum and urine levels of cephalexin. Postgrad. M. J. 46 (Suppl.): 60–64 (1970).

    Google Scholar 

  • Bailey, R.R.; Sharman, J.R.; O’Rourke, J. and Buttimore, A.L.: Hemodialysis and forced diuresis for tricyclic antidepressant poisoning. British Medical Journal 4: 230–231 (1974).

    Article  PubMed  CAS  Google Scholar 

  • Balogh, A.; Funfstuck, R.; Kangas, L.; Demme, U.; Sperschneider, H.; Traeger, A.; Stein, G. and Pekkarinen, A.: Comparative in vitro investigations on the dialyzability of hypnotic and psychotropic drugs by hemodialysis and controlled sequential ultradiffusion. Archives of Toxicology 4 (Suppl.): 335–337 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Bauer, L.A.; Raisys, V.A.; Watts, M.T. and Ballinger, J.: The pharmacokinetics of thiobendazole and its metabolites in an anephric patient undergoing hemodialysis and hemoperfu-sion. Journal of Clinical Pharmacology 22: 276–280 (1982).

    PubMed  CAS  Google Scholar 

  • Berman, S.; Boughton, W.; Sugihara, J.; Wong, E.; Sato, M. and Siemsen, A.: Pharmacokinetics of cefaclor in patients with end-stage renal disease and during hemodialysis. Antimicrobial Agents and Chemotherapy 14: 281–283 (1978).

    Article  PubMed  CAS  Google Scholar 

  • Bennett, W.M.; Bagby, S.P.; Golper, T.A. and Porter, G.A.: Vancomycin therapy for difficult infections in hemodialysis patients. Dialysis and Transplantation 6: 22–25 (1977).

    Google Scholar 

  • Bennett, W.M.; Muther, R.S.; Parker, R.A.; Feig, P.; Morrison, G.; Golper, J.A. and Singer, I.: Drug therapy in renal failure: Dosing guidelines for adults. Annals of Internal Medicine 93: 62–89, 286–325 (1980).

    PubMed  CAS  Google Scholar 

  • Bianchetti, G.; Grazini, G. and Brancaccio, D.: Pharmacokinetics and effects of propranolol in terminal uraemic patients and in patients undergoing regular dialysis treatment. Clinical Pharmacokinetics 1: 373–384 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Bickel, M.H.: Poisoning by tricyclic antidepressant drugs: General and pharmacokinetic considerations. International Journal of Clinical Pharmacology and Biopharmacy 11: 145–176 (1975).

    PubMed  CAS  Google Scholar 

  • Block, E.R.; Bennett, J.E.; Liovoti, L.G.; Klein, W.J.; Jr.; MacGregor, R.R. and Henderson, L.: Flucytosine and amphotericin, B: hemodialysis effects on the plasma concentration and clearance: studies in man. Annals of Internal Medicine 80: 613–617 (1974).

    PubMed  CAS  Google Scholar 

  • Bowersox, D.W.; Winterbauer, R.H.; Stewart, G.L.; Orme, B. and Barson, R.: Isoniazid dosage in patients with renal failure. New England Journal of Medicine 289: 84–87 (1973).

    Article  PubMed  CAS  Google Scholar 

  • Bruni, J.; Wang, L.H.; Marbury, T.C.; Lee, C.S. and Wilder, B.J.: Protein binding of valproic acid in uremic patients. Neurology 30: 557–559 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Bryan, C.S. and Stone, W.J.: “Comparably massive” penicillin G therapy in renal failure. Annals of Internal Medicine 82: 189–195 (1975).

    PubMed  CAS  Google Scholar 

  • Christopher, T.G.; Korn, N.; Blair, A.D.; Forrey, A.W.; O’Neil, M.A. and Cutler, R.E.: Gentamycin kinetics during hemodialysis. Kidney International 6: 38–44 (1974).

    Article  PubMed  CAS  Google Scholar 

  • Cimino, J.E. and Tierno, P.M.; Jr.: Hemodialysis properties of clindamycin (7-chloro-7-deoxylincomycin). Applied Microbiology 17: 446–448 (1969).

    PubMed  CAS  Google Scholar 

  • Collinsworth, K.A.; Stong, J.M.; Atkinson, A.J.; Winkle, R.A.; Perlroth, F. and Harrison, D.C.: Pharmacokinetics and metabolism of lidocaine in patients with renal failure. Clinical Pharmacology and Therapeutics 18: 59–64 (1975).

    PubMed  CAS  Google Scholar 

  • Craig, C.P. and Rifkin, S.I.: Pharmacokinetics and hemodialyzability of cefazolin in uremic patients. Clinical Pharmacology and Therapeutics 19: 825–829 (1976).

    PubMed  CAS  Google Scholar 

  • Cruz, I.A.; Cramer, N.C. and Parrish, A.E.: Hemodialysis in chlordiazepoxide toxicity. Journal of the American Medical Association 202: 438–440 (1967).

    Article  PubMed  CAS  Google Scholar 

  • Cunha, B.A.; Quintiliani, R.; Deglin, J.M.; Izard, M.W. and Nightingale, C.H.: Pharmacokinetics of vancomycin in anuria. Reviews of Infectious Diseases 3 (Suppl.): S269–272 (1981).

    PubMed  Google Scholar 

  • Curry, S.H.; Riddall, D.; Gordon, J.S.; Simpson, P.; Bins, T.B.; Rondel, R.K. and McMartin, C: Disposition of glutethimide in man. Clinical Pharmacology and Therapeutics 12: 849–875 (1972).

    Google Scholar 

  • Cutler, R.; Blair, A. and Kelly, M.: Flucytosine kinetics in subjects with normal and impaired renal function. Clinical Pharmacology and Therapeutics 24: 333–342 (1978).

    PubMed  CAS  Google Scholar 

  • Czcrwinski, A.W. and Pederson, J.A.: The pharmacology of cefa-mandole in patients with reduced renal function. Scandinavian Journal of Infectious Diseases 25 (Suppl.): 45–48 (1980).

    Google Scholar 

  • Danish, M.; Schultz, R. and Jusko, W.J.: Pharmacokinetics of gentamicin and kanamycin during hemodialysis. Antimicrobial Agents and Chemotherapy 6: 841–847 (1974).

    Article  PubMed  CAS  Google Scholar 

  • Dawling, S.; Lynn, K.; Rosser, R. and Braithwaite, R.: Nortrip-tyline metabolism in chronic renal failure: metabolite elimination. Clinical Pharmacology and Therapeutics 32: 322–329 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Dettli, L.: Drug usage in renal disease. Clinical Pharmacokinetics 1: 126–134 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Dromgoole, S.H.: The effect of hemodialysis on the binding capacity of albumin. Clinica Chimica Acta 46: 469–472 (1973).

    Article  CAS  Google Scholar 

  • Eastwood, J.B. and Curtis, J.R.: Carbenicillin administration in patients with severe renal failure. British Medical Journal 1: 486–487 (1968).

    Article  PubMed  CAS  Google Scholar 

  • Farid, N.R.; Glynn, J.P. and Kerr, D.N.S.: Haemodialysis in paracetamol selfpoisoning. Lancet 2: 396–398 (1972).

    Article  PubMed  CAS  Google Scholar 

  • Farrcl, P.C.; Grib, N.L.; Fry, D.L.; Popovich, R.P.; Broviac, J.W. and Babb, A.L.: A comparison of in vitro and in vivo soluteprotein binding interactions in normal and uremic subjects. Transactions of the American Society for Artificial Internal Organs 18: 268–276 (1972).

    Article  Google Scholar 

  • Faulkner, R.D.; Senekjian, H.O. and Lee, C.S.: Hemodialysis of doxcpin and desmethyldoxepin in uremic patients. International Journal of Artificial Organs (In press, 1983).

  • Floyd, M.; Hill, A.V.L.; Ormston, B.J.; Menzies, R. and Porter, R.: Quinine amblyopia treated by hemodialysis. Clinical Ne-phrology 2: 44–46 (1974).

    CAS  Google Scholar 

  • Francke, E.; Appel, G.B. and Neu, H.C.: Kinetics of intravenous amoxcillin in patients on long term dialysis. Clinical Pharmacology and Therapeutics 26: 31–35 (1979).

    PubMed  CAS  Google Scholar 

  • Frey, F.J.; Gambertoglio, J.G.; Frey, B.M.; Benet, L.Z. and Amend, W.J.: Nonlinear plasma protein binding and hemodialysis clearance of prednisolone. European Journal of Clinical Pharmacology 23: 65–74 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Gabriel, R.; Page, C.M.; Collier, J.; Houghton, G.W.; Templeton, R. and Thome, P.S.: Removal of metronidazole by hemodialysis. British Journal of Surgery 67: 553 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Gambertoglio, J.G.: Pharmacokinetic principles and renal disease. Dialysis and Transplantation 8: 8–23 (1979).

    Google Scholar 

  • Gibson, T.P.: Dialyzability of common therapeutic agents. Dialysis and Transplantation 8: 24–40 (1979).

    Google Scholar 

  • Gibson, P.F. and Wright, N.: Ethchlorvynol in biological fluids: specificity of assay methods. Journal of Pharmaceutical Sciences 61: 169–171 (1972).

    Article  PubMed  CAS  Google Scholar 

  • Gibson, T.P.; Matusik, E.; Nelson, L.D. and Biggs, W.A.: Artificial kidneys and clearance calculations. Clinical Pharmacology and Therapeutics 20: 720–726 (1976).

    PubMed  CAS  Google Scholar 

  • Gibson, T.P.; Atkinson, A.J.; Matusik, E.; Nelson, L.D. and Biggs, W.A.: Kinetics of procainamide and N-acetylprocainamide in renal failure. Kidney International 12: 422–429 (1977).

    Article  PubMed  CAS  Google Scholar 

  • Gibson, T.P.; Granneman, G.R.; Kallal, J.E. and Sennello, L.T.: Ccfsulodin kinetics in renal impairment. Clinical Pharmacology and Therapeutics 31: 602–608 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Goetz, DR.; Pancorbo, S.; Hoag, S. and Bloom, P.: Prediction of serum gentamycin concentrations in patients undergoing hemodialysis. American Journal of Hospital Pharmacy 37: 1077–1083 (1980).

    PubMed  CAS  Google Scholar 

  • Gold, C.H.; Buchanan, N.; Tingham, V.; Viljoen, M.; Strickwold, B. and Moodley, G.P.: Isoniazid pharmacokinetics in patients with chronic renal failure. Clinical Nephrology 6: 365–369 (1976).

    PubMed  CAS  Google Scholar 

  • Goodwin, N.J. and Friedman, E.A.: The effects of renal impairment, peritoneal dialysis and hemodialysis on serum sodium colistimethate levels. Annals of Internal Medicine 68: 984–994 (1968).

    PubMed  CAS  Google Scholar 

  • Gwilt, P.R.: Assessing drug removal by extracorporeal dialysis. Journal of Pharmaceutical Sciences 70: 345 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Gwilt, P. and Perrier, D.: Plasma protein binding and distribution characteristics of drugs as indices of hemodialyzability. Clinical Pharmacology and Therapeutics 24: 154–161 (1978).

    PubMed  CAS  Google Scholar 

  • Hallan, H.; Svarva, P.L.; Svartas, T.M. and Wideroe, T.: Azlo-cillin treatment of urinary tract infection in patients on hemodialysis. Scandinavian Journal of Infectious Diseases 29: 55–58 (1981).

    PubMed  CAS  Google Scholar 

  • Halpren, B.A.; Avline, S.G.; Coplan, N.S. and Brown, D.M.: Clearance of gentamycin during hemodialysis: Comparison of four artificial kidneys. Journal of Infectious Diseases 133: 627–636 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Handc, K.R.; Balow, J.E.; Drake, J.C.; Rosenberg, S.A. and Chabncr, B.A.: Methotrexale and hemodialysis. Annals of Internal Medicine 87: 495–496 (1977).

    Google Scholar 

  • Hawkins, S.S.; Alford, R.H.; Stone, W.J.; Smyth, R.D. and Pfeffer, M.: Ceforanide kinetics in renal insufficiency. Clinical Pharmacology and Therapeutics 30: 468–474 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Henderson, L.W.: Symptomatic hypotension during hemodi-alysis. Kidney International 17: 571–576 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Henderson, L.W. and Merrill, J.P.: Treatment of barbiturate intoxication. Annals of Internal Medicine 64: 876–891 (1966).

    Google Scholar 

  • Henderson, R.G.; Wheatley, T.; English, J.; Chakraborty, J. and Marks, V.: Variation in plasma prednisolone concentrations in renal transplant recipients given enteric-coated prednisoione. British Medical Journal 1: 1534–1536 (1979).

    Article  PubMed  CAS  Google Scholar 

  • Hervengt, C; Desager, J.P.; Muschart, J.M.; Tjandramaga, T.B.; Verbeeck, R. and Verberckmoes, R.: Influence of hemodialysis on the half-life of practolol in patients with severe renal failure. Journal of Clinical Pharmacology 15: 605–610 (1975).

    Google Scholar 

  • Hess, J.R.; Berman, S.J.; Boughton, W.H.; Sugihara, J.G.; Musgravc, J.E.; Wong, E.G.C. and Siemsen, A.M.: Pharmacokinetics of ceforanide in patients with end stage renal disease on hemodialysis. Antimicrobial Agents and Chemotherapy 17: 251–253 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Hoffman, T.A.; Cestero, R. and Bullock, W.E.: Pharmacodynamics of carbenicillin in hepatic and renal failure. Annals of Internal Medicine 73: 173–178 (1970).

    PubMed  CAS  Google Scholar 

  • Horn, J.R. and Hughes, M.L.: Disopyramide dialysability. Lancet 2: 214 (1978).

    Google Scholar 

  • Howell, S.B.; Blair, H.E.; Uren, J. and Frei, E.: Hemodialysis and enzymatic cleavage of methotrexate in man. European Journal of Cancer 14: 787–792 (1978).

    Article  PubMed  CAS  Google Scholar 

  • Hulter, H.N.; Licht, J.H.; Ilnicki, L.P. and Singh, S.: Clinical efficacy and pharmacokinetics of clonidine in hemodialysis and renal insufficiency. Journal of Laboratory and Clinical Med icine 94: 223–231 (1979).

    CAS  Google Scholar 

  • Humbert, G.; Fillastre, J.P.; Leroy, A.; Godin, M. and Van Win-zum, C: Pharmacokinetics of cefoxitin in normal subjects and in patients with renal insufficiency. Reviews of Infectious Diseases 1: 118–126 (1979a).

    Article  PubMed  CAS  Google Scholar 

  • Humbert, G.; Leroy, A.; Fillastre, J. and Godin, M.: Pharmacokinetics of cefadroxil in normal subjects and in patients with renal insufficiency. Chemotherapy 25: 189–195 (1979b).

    Article  PubMed  CAS  Google Scholar 

  • Hurwitz, A.: Gastrointestinal Drug Absorption: Effects of Antacids. Morselli et al. (Eds) Drug Interactions, pp. 21–31 (Raven Press, New York 1974).

    Google Scholar 

  • Iisalo, E.: Clinical pharmacokinetics of digoxin. Clinical Pharmacokinetics 2: 1–16 (1977).

    Article  PubMed  CAS  Google Scholar 

  • Iliopoulou, A.; Downey, K.; Chaput de Saintonge, D.M. and Turner, P.: Should erythromycin dose be altered in hemodialysis patients. European Journal of Clinical Pharmacology 23: 435–440 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Ing, T.S.; Mahurkar, S.D.; Dunea, G.; Hayashi, J.A.; Klawans, H.L. and Markey, W.S.: Removal of amantadine hydrochloride by dialysis in patients with renal insufficiency. Canadian Medical Association Journal 115: 515–516 (1976).

    PubMed  CAS  Google Scholar 

  • Ings, R.M.; Fillastre, J.P.; Godin, M.; Leroy, A. and Humbert, G.: The pharmacokinetics of cefotaxime and its metabolites in subjects with normal and impaired renal function. Review of Infectious Diseases 4: s379–391 (1982).

    Google Scholar 

  • Janicke, D.M.; Mangione, A.; Schultz, R.W. and Jusko, W.J.: Mezlocillin disposition in chronic hemodialysis patients. Antimicrobial Agents and Chemotherapy 20: 590–594 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Josselson, J.; Narang, P.K.; Adir, J.; Yacobi, A. and Sadler, J.H.: Bretylium kinetics in renal insufficiency. Clinical Pharmacology and Therapeutics 33: 144–150 (1983).

    Article  PubMed  CAS  Google Scholar 

  • Jusko, W.J. and Weintraub, M.: Myocardial distribution of digoxin and renal function. Clinical Pharmacology and Therapeutics 16: 449–454 (1974).

    PubMed  CAS  Google Scholar 

  • Jusko, W.J.; Lewis, G.P. and Schmitt, G.W.: Ampicillin and hetacillin pharmacokinetics in normal and anephric patients. Clinical Pharmacology and Therapeutics 14: 90–99 (1973).

    PubMed  CAS  Google Scholar 

  • Karim, A.: Disopyramide dialyzability. Lancet 2: 214 (1978).

    Article  Google Scholar 

  • Kirch, W.; Kohler, H. and Axthelm, T.: Pharmacokinetics of guanfacine in patients undergoing hemodialysis. European Journal of Drug Metabolism and Pharmacokinetics 4: 277–280 (1982).

    Article  Google Scholar 

  • Knepshield, J.H.; Schreiner, G.E.; Lowenthal, D.T. and Gelfand, M.C.: Dialysis of poisons and drugs. Transactions of the American Society for Artificial Internal Organs 19: 590–633 (1973).

    Article  PubMed  CAS  Google Scholar 

  • Koch-Weser, J.: Pharmacokinetics of procainamide in man. Annals of the New York Academy of Sciences 170: 370–382 (1971).

    Article  Google Scholar 

  • Kramer, P.: Digitalis pharmacokinetics and therapy with respect to impaired renal function. Klinische Wochenschrift 55: 1–11 (1977).

    Article  PubMed  Google Scholar 

  • Kreeft, J.H.; Ogilvie, R.I. and Dufresne, L.R.: Metronidazole kinetics in dialysis patients. Surgery 93: 149–153 (1983).

    PubMed  CAS  Google Scholar 

  • Krumlovsky, F.A.; Emmerman, J.; Parker, R.H.; Wisgerhof, M. and DelGreco, F.: Dialysis in treatment of neomycin over-dosage. Annals of Internal Medicine 76: 443–446 (1972).

    PubMed  CAS  Google Scholar 

  • Laskin, O.L.; Longstreth, J.A.; Whelton, A.; Rocco, L.; Lietman, P.S.; Krasny, H.C. and Keeney, R.E.: Acyclovir kinetics in end-stage renal disease. Clinical Pharmacology and Therapeutics 31: 594–601 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Lee, C.S.: The assessment of fractional drug removal by extra-corporeal dialysis. Biopharmaceutics and Drug Disposition 3: 165–173 (1982).

    Article  CAS  Google Scholar 

  • Lee, P.; Crutch, E.R. and Morrison, R.B.I.: Doxycycline: studies in normal subjects and patients with renal failure. New Zealand Medical Journal 75: 355–358 (1972).

    PubMed  CAS  Google Scholar 

  • Lee, C.S.; Marbury, T.C.; Perrin, J.H. and Fuller, J.J.: Hemodialysis of theophylline in uremic patients. Journal of Clinical Pharmacology 19: 219–226 (1979).

    PubMed  CAS  Google Scholar 

  • Lec, C.S.; Bruni, J.; Marbury, T.C.; Perchalski, R.J. and Wang, L.H.: Hemodialysis and total body elimination of carbamaz-epine during chronic hemodialysis. Clinical Toxicology 17: 429–438 (1980a).

    Article  Google Scholar 

  • Lcc, C.S.; Marbury, T.C. and Benet, L.Z.: Clearance calculations in hemodialysis: Application to blood, plasma and dialysate measurements for ethambutol. Journal of Pharmacokinetics and Biopharmaceutics 8: 65–81 (1980b).

    Google Scholar 

  • Lcc, C.S.; Marbury, T.C; Wang, L.H. and Cade, R.J.: Hemodialysis for acetaminophen detoxification. Clinical Toxicology 18: 431–439 (1981a).

    Article  Google Scholar 

  • Lee, C.S.; Wang, L.H.; Majeske, B.L. and Marbury, T.C.: Phar-macokinetics of dyphylline elimination by uremic patients. Journal of Pharmacology and Experimental Therapeutics 217: 340–344 (1981b).

    PubMed  CAS  Google Scholar 

  • Lee, C.S.; Marbury, T.C.; Perchalski, R.T. and Wilder, B.J.: Phar-macokinetics of primidone elimination by uremic patients. Journal of Clinical Pharmacology 22: 301–308 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Lee, C.S.; Paterson, J. and Marbury, T.C.: Comparative Phar-macokinetics of theophylline in hemodialysis and peritoneal dialysis. Journal of Clinical Pharmacology 23: 274–280 (1983).

    PubMed  CAS  Google Scholar 

  • Leroy, A.; Humbert, G. and Fillastre, J.P.: Pharmacokinetics of moxalactam in subjects with normal and impaired renal function. Antimicrobial Agents and Chemotherapy 19: 965–971 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Letourneau-Saheb, I.; Lapierre, L. and Daigneault, R.: Gentamycin pharmacokinetics during hemodialysis in patients suffering from chronic renal failure. International Journal of Clinical Pharmacology and Biopharmaceutics 15: 116–121 (1977).

    CAS  Google Scholar 

  • Lelteri, J.M.; Miraflor, F.; Tablante, V. and Siddigi, S.: Doxycycline (Vibramycin®) in chronic renal failure. Nephron 11: 318–324 (1973).

    Article  Google Scholar 

  • Levy, G.: Pharmacokinetics in renal disease. American Journal of Medicine 62: 461–465 (1977).

    Article  PubMed  CAS  Google Scholar 

  • Levy, G.; Gibson, J.P.; Whitman, W. and Procknal, J.: Hemodialysis clearance of theophylline. Journal of the American Medical Association 237: 1466–1467 (1977).

    Article  PubMed  CAS  Google Scholar 

  • Lewi, P.J.; Boelaert, J.; Daniels, R.; De Meyere, R.; Van Landuvt, H. and Heykants, J.J.P.: Pharmacokinetic profile of intravenous miconazole in man. European Journal of Clinical Pharmacology 10: 49–54 (1976).

    Article  CAS  Google Scholar 

  • Lowenthal, D.T.; Briggs, W.A; Gibson, T.P.; Nelson, H. and Cirksena, W.J.: Pharmacokinetics of oral propranolol in chronic renal disease. Clinical Pharmacology and Therapeutics 16: 761–769 (1974).

    PubMed  CAS  Google Scholar 

  • Ma, K.W.; Brown, D.C.; Masler, D.S. and Silvis, S.E.: Effects of renal failure on blood levels of cimetidine. Gastroenterology 74: 473–477 (1978).

    PubMed  CAS  Google Scholar 

  • Maddock, R.K. and Bloomer, H.A.: Meprobamate overdose: evaluation of its severity and methods of treatment. Journal of the American Medical Association 201: 999–1003 (1967).

    Article  PubMed  Google Scholar 

  • Marbury, T.C.; Lee, C.S.; Burni, J. and Wilder, B.J.: The pharmacokinetics of valproic acid in patients with chronic renal failure during hemodialysis. Dialysis and Transplantation 9: 961–964 (1980a).

    Google Scholar 

  • Marbury, T.C.; Wang, L.H. and Lee, C.S.: Hemodialysis of acetaminophen in uremic patients. International Journal of Artificial Organs 5: 263–266 (1980b).

    Google Scholar 

  • Marbury, T.C.; Lee, C.S.; Perchalski, R.J. and Wilder, B.J.: Hemodialysis clearance of ethosuximide in end-stage renal disease patients. American Journal of Hospital Pharmacy 38: 1757–1760 (1981).

    PubMed  CAS  Google Scholar 

  • Marbury, T.C.; Sheppard, J.E.; Gibbons, K. and Lee, C.S.: Combined antidotal and hemodialysis treatments for nitroprusside-induced cyanide toxicity. Journal of Toxicology — Clinical Toxicology 19: 475–482 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Mauer, S.M.; Paxson, C.L.; Von Hartizsch, B.; Buselmeier, T.J. and Kjellstrand, C.J.: Hemodialysis in an infant with pro-poxyphene intoxication. Clinical Pharmacology and Therapeutics 17: 88–92 (1975).

    PubMed  CAS  Google Scholar 

  • McCloskey, R.V.; Terry, E.E.; McCracken, A.W.; Sweeney, M.J. and Forland, M.F.: Effects of hemodialysis and renal failure on serum and urine concentrations of cephapirin sodium. Antimicrobial Agents and Chemotherapy 1: 90–93 (1972).

    Article  PubMed  CAS  Google Scholar 

  • Murray, T.G.; Chiang, S.T.; Koepke, H.H. and Walker, B.R.: Renal disease, age and oxazepam kinetics. Clinical Pharmacology and Therapeutics 30: 805–809 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Nauta, E.H. and Manie, H.: Dicloxacillin and cloxacillin: pharmacokinetics in healthy and hemodialysis subjects. Clinical Pharmacology and Therapeutics 20: 98–108 (1976).

    PubMed  CAS  Google Scholar 

  • Nauta, E.H.; Mattie, H. and Goslings, W.R.D.: Pharmacokinetics of cloxacillin in patients on chronic intermittent haemodialy-sisand in healthy subjects. Chemotherapy 19: 261–271 (1973).

    Article  PubMed  CAS  Google Scholar 

  • Nieto, M.J.; Lanao, J.M.; Dominguez-Gil, A.; Tabernero, J.M. and Macias, J.F.: Elimination of cefroxadine from patients undergoing dialysis. European Journal of Clinical Pharmacology 24: 109–112 (1983).

    Article  PubMed  CAS  Google Scholar 

  • Odar-Cederlof, I. and Borgâ, O.: Kinetics of diphenylhydantoin in uremic patients: Consequences of decreased plasma protein binding. European Journal of Clinical Pharmacology 7: 31–37 (1974).

    Article  PubMed  CAS  Google Scholar 

  • Pahl, M.V. and Vaziri, N.D.: In-vivo and in-vitro hemodialysis studies of thiocyanate. Journal of Toxicology: Clinical Toxicology 19: 965–974 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Parry, M.F. and Neu, H.C.: Pharmacokinetics of ticarcillin in patients with abnormal renal function. Journal of Infectious Diseases 133: 46–49 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Pechere, J.C. and Dugal, R.: Pharmacokinetics of intravenously administered tobramycin in normal volunteers and in renalimpaired hemodialyzed patients. Journal of Infectious Diseases 134 (Suppl.): 5118–5124 (1976).

    Article  Google Scholar 

  • Pechere, J. and Dugal, R.: Clinical pharmacokinetics of amino-glycosides. Clinical Pharmacokinetics 4: 170–199 (1979).

    Article  PubMed  CAS  Google Scholar 

  • Ponstal, P.G.; Bismuth, C; Baud, F. and Galliot, M.: Respective roles of gastric lavage, hemodialysis, hemoperfusion, diuresis, and hepatic metabolism in the elimination of a massive meprobamate overdose. Nouvelle Presse Médicale 11: 1557–1558 (1982).

    Google Scholar 

  • Randall, R.E.; Singh, R.; Laster, J.; Belle, C. and Setter, J.G.: Increased intracranial pressure from unsustained levels of plasma mannitol during hemodialysis. Journal of Laboratory and Clinical Medicine 70: 129–137 (1967).

    PubMed  CAS  Google Scholar 

  • Rcgeur, L.; Colding, H.; Jensen, H. and Kampmann, J.P.: Pharmacokinetics of amikacin during hemodialysis and peritoneal dialysis. Antimicrobial Agents and Chemotherapy 11: 214–218 (1977).

    Article  Google Scholar 

  • Reidenberg, M.M.: The binding of drugs to plasma proteins and the interpretation of measurements of plasma concentrations of drugs in patients with poor renal function. American Journal of Medicine 62: 466–469 (1977a).

    Article  PubMed  CAS  Google Scholar 

  • Reidenberg, M.M.: The biotransformation of drugs in renal failure. American Journal of Medicine 62: 482–485 (1977b).

    Article  PubMed  CAS  Google Scholar 

  • Reinarz, J.A. and Mclntosh, D.A.: Lincomycin excretion in patients with normal renal function, severe azotemia and with hemodialysis and peritoneal dialysis. Antimicrobial Agents and Chemotherapy 5: 232–244 (1965).

    PubMed  CAS  Google Scholar 

  • Reisberg, B.E. and Mandelbaum, J.M.: Cephalexin: absorption and excretion as related to renal function and hemodialysis. Infection and Immunity 3: 540–543 (1971).

    PubMed  CAS  Google Scholar 

  • Reuning, R.H.; Sams, R.A. and Notari, R.E.: Role of pharmaco-kinetics in drug dosage adjustment: Pharmacologic effect, kinetics and apparent volume of distribution of digoxin. Journal of Clinical Pharmacology 13: 127–141 (1973).

    CAS  Google Scholar 

  • Richens, A.: Clinical pharmacokinetics of phenytoin. Clinical Pharmacokinetics 4: 153–169 (1979).

    Article  PubMed  CAS  Google Scholar 

  • Riva, E.; Fossali, E. and Bettinelli, A.: Kinetics of furosemide in children with chronic renal failure undergoing regular hemodialysis. European Journal of Clinical Pharmacology 21: 303–306 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Roberts, A.; Eastwood, T.; Gower, P.; Fenton, C.M. and Curtis, JR.: Serum and plasma concentrations of clindamycin following a single intra-muscular injection of clindamycin phosphate in maintenance hemodialysis patients and normal subjects. European Journal of Clinical Pharmacology 14: 435–439 (1978).

    Article  PubMed  CAS  Google Scholar 

  • Rodrigo, F.; Shideman, J.; McHugh, R.; Buselmeier, T. and Kjellstrand, C: Osmolality changes during hemodialysis. Annals of Internal Medicine 86: 554–561 (1977).

    PubMed  CAS  Google Scholar 

  • Rosenbaum, J.L.; Winsten, S.; Kramer, M.S.; Moros, J. and Raja, R.: Resin hemoperfusion in the treatment of drug intoxification. Transactions of the American Society for Artificial Internal Organs 16: 134–140 (1970).

    PubMed  CAS  Google Scholar 

  • Rudnick, M.; Morrison, G.; Walker, B. and Singer, I.: Renal failure, hemodialysis and nafcillin kinetics. Clinical Pharmacology and Therapeutics 20: 413–423 (1976).

    PubMed  CAS  Google Scholar 

  • Rustein, D.D.; Catelli, W.P. and Nickerson, R.J.: Heparin and human lipid metabolism. Lancet 1: 1003–1008 (1969).

    Article  Google Scholar 

  • Schmidt, P.; Korn, A.; Hitzenberger, G.; Zazgornik, J. and Kopsa, H.: Pharmacokinetics of trimethoprim and sulfametrol in patients with end stage renal failure and hemodialysis treatment. Wiener Medizinische Wochenschrift 130: 171–173 (1980).

    PubMed  CAS  Google Scholar 

  • Schusziarra, V.; Ziekursch, V.; Schlamp, R. and Siemensen, H.C.: Pharmacokinetics of azathioprine under hemodialysis. International Journal of Clinical Pharmacology and Biopharmacy 14: 298–302 (1976).

    PubMed  CAS  Google Scholar 

  • Senekjian, H.O.; Lee, C.S.; Kuo, T.H.; Au, D.S. and Krothapalli, R.: Absorption and disposition of ibuprofen in hemodialyzed urcmic patients. European Journal of Rheumatology and Inflammation. (In press, 1983).

  • Setter, J.G.; Mäher, J.F. and Schreiner, G.E.: Barbiturate intoxication. Archives of Internal Medicine 117: 224–236 (1966).

    Article  PubMed  CAS  Google Scholar 

  • Sherlock, J.E. and Letteri, J.M.: Effect of hemodialysis on methylprednisolone plasma levels. Nephron 18: 208–211 (1977).

    Article  PubMed  CAS  Google Scholar 

  • Skoutakis, V.A.; Acchiardo, S.R.; Meyer, M.C. and Hatch, F.E.: Folic acid dosage for chronic hemodialysis patient. Clinical Pharmacology and Therapeutics 18: 200–204 (1975).

    PubMed  CAS  Google Scholar 

  • Slaughter, R.L.; Cerra, F.B. and Koup, J.R.: Effect of hemodialysis on total body clearance of chloramphenicol. American Journal of Hospital Pharmacy 37: 1083–1086 (1980).

    PubMed  CAS  Google Scholar 

  • Spyker, D.A.; Gober, L.L.; Scheid, W.M.; Sande, M.A. and Bolton, W.K.: Pharmacokinetics of cefaclor in renal failure: Effects of multiple doses and hemodialysis. Antimicrobial Agents and Chemotherapy 21: 278–281 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Stec, G.P.; Atkinson, A.J.; Nevin, M.J.; Thenot, J.P.; Ruo, T.I.; Gibson, T.P.; Ivanovich, P. and Greco, F.: N-acetylprocainamide pharmacokinetics in functionally anephric patients before and after perturbation by hemodialysis. Clinical Pharmacology and Therapeutics 26: 618–627 (1979).

    PubMed  CAS  Google Scholar 

  • Sullivan, J.F. and Eisenstein, A.B.: Ascorbic acid depletion in patients undergoing chronic hemodialysis. American Journal of Clinical Nutrition 23: 1339–1346 (1970).

    PubMed  CAS  Google Scholar 

  • Takki, S.; Gambertoglio, J.G.; Honda, D.H. and Tozer, T.N.: Pharmacokinetic evaluation of hemodialysis in acute drug overdose. Journal of Pharmacokinetics and Biopharmaceutics 6: 427–442 (1978).

    Article  PubMed  CAS  Google Scholar 

  • Tilstone, W.J.; Winchester, J.F. and Reavery, P.C.: The use of pharmacokinetic principles in determining the effectiveness of removal of toxins from blood. Clinical Pharmacokinetics 4: 23–37 (1979).

    Article  PubMed  CAS  Google Scholar 

  • Tjandramaga, T.B.; Thomas, J.; Verbeeck, R.; Verberckmoes, R. and De Schepper, P.J.: The effect of end-stage renal failure and hemodialysis on the elimination kinetics of sotaolol. British Journal of Clinical Pharmacology 3: 259–265 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Tozer, T.N.; Witt, L.D.; Gee, L.; Tong, T.G. and Gambertoglio, J.G.: Evaluation of hemodialysis for ethchlorvynol overdose. American Journal of Hospital Pharmacy 31: 986–989 (1974).

    PubMed  CAS  Google Scholar 

  • Vaziri, N.D.; Ness, R.L. and Barton, C.H.: Hemodialysis clearance of cimetidine. Archives of Internal Medicine 138: 1685–1686 (1978).

    Article  PubMed  CAS  Google Scholar 

  • Vaziri, N.D.; Saiki, J.K. and Hughes, W.: Clearance of lidocaine by hemodialysis. Southern Medical Journal 72: 1567–1568 (1979).

    Article  PubMed  CAS  Google Scholar 

  • Venuto, R.C. and Plaut, M.: Cephalothin handling in patients undergoing hemodialysis. Antimicrobial Agents and Chemotherapy 10: 50–52 (1970).

    PubMed  CAS  Google Scholar 

  • Wang, L.H.; Lee, C.S. and Marbury, T.C.: Hemodialysis of mefenamic acid in uremia. American Journal of Hospital Pharmacy 37: 956–958 (1980).

    PubMed  CAS  Google Scholar 

  • Wang, L.H.; Lee, C.S.; Majeske, B.L. and Marbury, T.C.: Clearance and recovery calculations in hemodialysis: Application to plasma, red blood cell, and dialystate measurements for cyclophosphamide. Clinical Pharmacology and Therapeutics 29: 365–372 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Watanabe, A.S.: Pharmacokinetic aspects of the dialysis of drugs. Drug Intelligence and Clinical Pharmacy. 11: 407–416 (1977).

    CAS  Google Scholar 

  • Woie, L. and Oyri, A.: Quinidine intoxication treated with hemodialysis. Acta Medica Scandinavica 195: 237–239 (1974).

    Article  PubMed  CAS  Google Scholar 

  • Wood, A.J.; Vestal, R.E.; Spannuth, C.L.; Stone, W.J.; Wilkinson, G.R. and Shand, D.G.: Propranolol disposition in renal failure. British Journal of Clinical Pharmacology 10: 561–566 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Wu, M.J.; Ing, T.S.; Soung, L.S.; Daugirdas, J.T.; Hano, J.E. and Gandhi, V.C.: Amantadine hydrochloride pharmacokinetics in patients with impaired renal function. Clinical Nephrology 17: 19–23 (1982).

    PubMed  CAS  Google Scholar 

  • Ych, B.K.; Dayton, P.G. and Waters, W.C. III.: Removal of alpha methyldopa (Aldomet) in man by dialysis. Proceedings of the Society for Experimental Biology and Medicine 135: 840–843 (1970).

    Google Scholar 

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  1. Department of Pharmaceutics, University of Houston at Texas Medical Center, 1441 Moursund Street, Houston, Texas, 77030, USA

    Ching-san C. Lee & Thomas C. Marbury

  2. Department of Internal Medicine, Orlando Regional Medical Center, Orlando, USA

    Ching-san C. Lee & Thomas C. Marbury

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Lee, Cs.C., Marbury, T.C. Drug Therapy in Patients Undergoing Haemodialysis Clinical Pharmacokinetic Considerations. Clin Pharmacokinet 9, 42–66 (1984). https://doi.org/10.2165/00003088-198409010-00003

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