Best practice

At my unit and in the hospital doing acutes, we give the meds any time, and antibiotics the last hour.

In unit, we give meds anytime. In acutes, we give only normally give Epo and near end of tx.

Depends on the drug. For EPO and iron it doesn't matter. For other drugs I usually refer to our renal drug handbook to find out the dialysability of the drug, and then decide when they should be given. Not every drug is dialysed.

this is from my experience and what i've been taught...

epo, iron, vitamin D, usually give whenever during the treatment. however, i usually wait to give the epo dose if diastolic is >110, something about epo will keep the diastolic elevated if it is elevated already. i know some docs would even hold the dose altogether if the diastolic is above 110. with iv iron i usually wait until towards the end of the treatment when the patient is on no heparin, the venous chamber tends to be more prone to clotting once iv iron is given, unless you can really flush the lines with NS. antiobiotics really should be given after dialysis, even vancomycin. i read a research article somewhere recently that says vancomycin is also dialyzable. but then, most patients i've encountered would not stay a minute longer than their treatment time, so there's the dilemma. but the practice i've learned and seen is give the vanco no sooner than one hour left into the treatment, gentamicin has to wait until after dialysis.

you can always call the drug manufacturers...they will provide official instructions or statements...

Vanc is dialyzable, I can't remember the exact percentage, but given in the last hour the loss is minimal. For patients with bigger doses or who have had reactions in the past we might give it more slowly, but with the dialysis flow off for the final 30min (usually have to beg and plead for them to do the extra 30!)