Giving Calcijex (Calcitriol) IV during or at end of dialysis

[montreal2008]

Hello,

While it is true that the CPS recommends giving the calcijex injection at the end of dialysis, a study by Ash (1997) proves that the molecule is not dialyzable and it can be injected at any time during dialysis.

In our centre, we give it at the end of dialysis, but I would like to know if there are any centres where you do give it at any time during the treatment.

Thanks

[rain888]

In my wokeplace, same as yours,before concludsion 5--10 mins give calcijex.

[bluefabian]

I agree with what you said Montreal2008. Us, nurses tend to stick to the safer side of things (not that, that is bad) sometimes with less rationale and reasoning.

Here, I gave calcitriol IV about 20 minutes or close to termination. But same as you too, I wonder if that is feasible since we don't really know the size of the molecule. That also applies to erythropoeitin, which I gave through the venous port. If the molecule is big enough, I don't see any problem giving it through the arterial port.

Talking about these, I think there is a reference about dialyzable drugs around. Anyone has the link?

[Tish88]

We give ours anytime during the treatment.

[montreal2008]

Hello BlueFabian,

The calcitriol is a middle size molecule, 416 daltons in fact, so it could theoretically be dialyzed, HOWEVER, once given IV, only 0.4 % is present as free calcitriol, the rest is bound to plasma proteins ( 85 % to vitamin D binding protein and 14.6 % to albumin), thus the drug is not removed by the dialyzer. However the pharmaceutical company does not recommed using it anytime during duialysis. ( need in vivo studies to prove that it can be given anytine).

If you are interested, you can read Lack of removal of calcitriol during hemodialysis, by Stephen Ash, Paul Gloecklner and Stephanie Barnett, published in jounal of the American Society of Nephrology in 1997, pp1587-1591. Moreover, calicitriol (calcijex) does not bind to the plastic tubing or drip chambers. This is why I wanted to know if any centers are following the CPS to a T. (We are).

For the Erythopoietin, I could tell you that it has to be given in the venous port so it goes directly into the patient's blood stream because it is adsorbed to the plastic material of tubings and drip chambers.

Thank you for answering my initial question.

[montreal2008]

Hello Tish,

Thank you very much for your answer,

I am glad to hear that you give the calcitriol anytime during treatment. Do you have any documemtation that can support your practice?

On my side, I wrote to the pharmaceutical company and their answer was that they would not outright recommend giving the calcijex anytime during dialysis as the study I refer to is done In Vitro. So our nephrologist did not want to change our present way of giving the calcijex i.e. the end of treatment. The advantage of giving it anytime is that ther eis less chance of omission, also, hypotension episodes tend to happen toward the end so in the rush, the clacijex may be forgotten.

Thanks

:)

[diabo, RN]

Talking about these, I think there is a reference about dialyzable drugs around. Anyone has the link?

Here it is:

http://www.nephrologypharmacy.com