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The pharmacokinetics of metformin in patients receiving intermittent haemodialysis.

The aims of this study were to characterise the population pharmacokinetics of metformin in patients receiving haemodialysis, and to determine the doses that will maintain median metformin plasma concentrations below 5mg L-1 for a typical individual. Metformin plasma concentrations from five patients receiving thrice weekly intermittent haemodialysis followed by metformin 500mg post-dialysis were fitted to a published pharmacokinetic model. Additional models to describe the dialytic pharmacokinetics of metformin were explored. Doses of 250 and 500 post-dialysis were simulated from the model for a typical haemodialysis patient. The published two compartment pharmacokinetic model with an additional parameter to describe haemodialysis clearance provided a reasonable fit to the data. Deterministic simulations from the model for a typical individual suggest that metformin doses of 250-500mg post-dialysis and 250mg given once daily should maintain median metformin plasma concentrations below 5mg L-1 .