Drugs To Give/Not Give Before Dialysis

Specializes in Labor and Delivery, Medical, Oncology.

I work nights on a medical unit, and we have several hemodialysis patients at any given tits; I'm charged with getting this patient set up for breakfast and ready to go to HD between 0600 and 0700. My unit has an ongoing debate/confusion about which meds to give before patients go to dialysis and which to hold because they'll dialyze off. All "daily" or "BID" meds have scheduled administration times at 0900. The dialysis nurses do not give meds or let patients eat during HD, so if I don't provide them before they go, they end up being late (as in the early afternoon or later). I always give Synthroid (scheduled for 0600) and Renagel, Phoslo, insulin, and any other meds that MUST go with breakfast, but what about the rest of the AM meds? I've heard, "Don't give the antibiotics," but today's pharmacist contradicted that idea. Can anyone give me some hints, classification by classification, and which meds I should hold until after dialysis? Thanks for your help!

What Members Are Saying (AI-Generated Summary)

Members are discussing which medications to give to hemodialysis patients before their treatment and which ones to hold. Factors such as the type of filter used, protein-bound nature of certain drugs, and sieving coefficient are discussed. Suggestions include consulting with dialysis nurses, pharmacists, and renal doctors for guidance on medication administration for dialysis patients.

5 Answers

Specializes in Dialysis.

Many factors influence drug removal by dialysis, the major ones being the type of filter used in your facility, whether or not a drug is protein-bound or water-soluble, molecular size, and the sieving coefficient (rate it is removed) of a particular medicine. Yes, it's a lot of factors involved. Synthroid is protein bound, so it will not pass through the dialysis filter. So is dilantin and digoxin. Your pharmacist isn't particularly helpful, as most antibiotics will dialyze right out, at least with the F180 filters used in my institution. I participated in a study on Vancomycin in which we drew labs every 15 minutes, and it was nearly 100% gone at the end of even a 3-hour treatment. Pain medications are different because receptors in the body latch on to the drug, so although some may be removed by dialysis, the patient will still obtain relief. BP meds are held not because they are removed by dialysis but because it hinders fluid removal. As fluid is removed, BP drops. You also might want to ask one of the nephrologists if they would be willing to give a short in-service in your unit about drug removal by dialysis.

Specializes in Trauma Surgical ICU.

I work a renal floor for a year. We held all BP meds and ABX before HD. If the pt needed vans, the MD would write to be given the last 30 minutes of hemo. All other meds were held until they came back. They were late, but we had a spot where we could state it was because of hemo.

Your in-house dialysis nurses can be great resources. If unsure, I will call them and ask which meds they want me to give/hold. I never provide vitamins because they are water-soluble. As for blood pressure meds, you can get parameters from the renal doc. The other day I had the order to hold all bp meds for systolic.

Just a few tips, but the bottom line: Use your resources. Pharmacists, dialysis nurses, or renal doc if you are unsure about giving a med.

Specializes in Labor and Delivery, Medical, Oncology.

Thank you both! Very helpful. I'll ask what kind of filters they use the next time I talk to the dialysis RNs.

Specializes in Dialysis.

Save yourself some time. A little book, Dialysis of Drugs by Genzyme, gives you the most common drugs and whether or not they are dialyzed off during dialysis.

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