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Drugs and Dialysis

Uremic patients usually present a large variety of clinical problems, involving different systems and organs, so they need several pharmacological agents. Accordingly, a good knowledge of metabolism, pharmacokinetics, elimination ways of each drug and of interactions between drugs and uremic syndrome is important. It is well known that uremia alters drug absorption, metabolism, protein binding and excretion. Such remarks outline that, since any pharmacological agent may cause toxic effects, a drug should be given only when necessary; moreover, in case of administration, the most suitable to the situation should be chosen. In patients with renal diseases, and particularly in uremics, drugs excreted by the kidney should be given only in case of nephrological and urological indications. When other organs are involved, pharmacological agents excreted via extra-renal routes should be better preferred. On the other hand, when a patient with renal failure needs a drug excreted mainly by the kidney, two risks should be carefully evaluated: eccessive amounts and toxicity of the drug or suboptimal, and therefore ineffective, administrations. In renal failure, toxic blood concentrations may be avoided reducing either each dosage, or the frequency of administrations, or both doses and frequency. In patients undergoing chronic dialysis, problems enlarge and increase because: new pathological alterations occur and further drugs are required metabolic changes induced by dialysis may interfere with drugs dialysis removes varying amounts of drug and supplemental doses are needed. Changes in calcium and phosphorus metabolism, linked to secondary and tertiary hyperparathyroidism, may be an example of new disorders. Digoxin is well known to cause arrhythmias when pH, Ca and K intracellular-extracellular ratios are rapidly modified by dialysis: this shows the interactions between metabolic changes and drugs in dialyzed people. G. La Greca, S. Biasioli, D. Borin, A. Brendolan, S. Chiaramonte, A. Fabris, M. Feriani, E. Pisani, C. Ronco