Many patients with renal insufficiency undergo dialysis, which may increase drug clearance. A drug removed by dialysis may require supplemental drug dosages to maintain therapeutic levels.
The most important characteristics of a drug that determine the ability of dialysis to remove a significant amount of drug are:
(1) the volume of distribution
(2) the degree of binding by the drug to plasma proteins
(3) the nonrenal clearance of the drug.
Dialysis is effective in removing a drug if:
(1) the volume of distribution is less than 1 L/kg
(2) the drug is not highly bound to plasma proteins
(3) the drug has a small nonrenal clearance (< 400 mL/min)
Blood levels of the drugs should be determined to help guide supplemental drug therapy after hemodialysis.
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