Medication and Hemodiafiltration

Zandvliet, Anthe S.; Touw, Daniël J.; Penne, E. L.

doi:10.1007/978-3-319-23332-1_24

Cited by 4 publications

(3 citation statements)

References 52 publications

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“…Furthermore, the amount of drug removal during an HDF session can be calculated, based on drug concentrations of samples collected pre- and post-filter at several time points. This concept is elucidated in more detail by Zandvliet et al [17]. …”

Section: Pharmacokinetics and Pharmacodynamics Of Anti-infective Agenmentioning

confidence: 99%

Optimization of anti-infective dosing regimens during online haemodiafiltration

Jager

Zandvliet

Touw

et al. 2017

Clinical Kidney Journal

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Online haemodiafiltration (HDF) is increasingly used in clinical practice as a routine intermittent dialysis modality. It is well known that renal impairment and renal replacement therapy can substantially affect the pharmacokinetic behaviour of several drugs. However, surprisingly few data are available on the need for specific dose adjustments during HDF. Due to convection, drug clearance may be increased during HDF as compared with standard haemodialysis. This may be of particular interest in patients undergoing anti-infective therapy, since under-dosing may compromise patient outcomes and promote the emergence of bacterial resistance. Drug clearance during HDF is determined by (i) dialysis characteristics, (ii) drug characteristics and (iii) patient characteristics. In this review, we will discuss these different determinants of drug clearance during HDF and advise on how to adjust the dose of antibacterial, antimycotic and antiviral agents in patients undergoing HDF. In addition, the possible added value of therapeutic drug monitoring is discussed. The review provides guidance for optimization of anti-infective dosing regimens in HDF patients.

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Section: Pharmacokinetics and Pharmacodynamics Of Anti-infective Agenmentioning

confidence: 99%

Optimization of anti-infective dosing regimens during online haemodiafiltration

Jager

Zandvliet

Touw

et al. 2017

Clinical Kidney Journal

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“…Higher filtration fractions lead to excessive hematocrit in the dialyzer, resulting in high pressures, membrane fouling, increased albumin loss, and risk of clotting, as frequently observed during online HDF, particularly in post-dilution mode, with the necessity of 10%-25% more heparin than regular HD treatment. 115 Heparin is associated with adverse effects, such as an obvious increased risk of bleeding and the risk of heparin-induced auto-antibodies. In patients with high risk of bleeding, pre-filter intermittent saline flushes are often used in clinical practice, with boluses between 25 and 200 ml infused every 15 to 30 min.…”

Section: Anti Coag Ul Ati On Sys Temmentioning

confidence: 99%

“…Clotting events of dialyzer fibers and membrane pores often occur, reducing the efficiency of the dialytic treatment. Higher filtration fractions lead to excessive hematocrit in the dialyzer, resulting in high pressures, membrane fouling, increased albumin loss, and risk of clotting, as frequently observed during online HDF, particularly in post‐dilution mode, with the necessity of 10%–25% more heparin than regular HD treatment 115 . Heparin is associated with adverse effects, such as an obvious increased risk of bleeding and the risk of heparin‐induced auto‐antibodies 116 …”

Section: Anticoagulation Systemmentioning

confidence: 99%

Updates on hemodialysis techniques with a common denominator: The personalization of the dialytic therapy

Monardo

Lacquaniti

Campo

et al. 2021

Seminars in Dialysis

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Morbidity and mortality marginally decreased over the last three decades in hemodialyzed (HD) patients, despite the introduction of multiple pharmacological and technological advancement. 1 Several randomized controlled studies failed to demonstrate the superiority of one procedure, schedule, or pharmacological interventions on survival and, consequently, weak level of recommendations has been revealed by best practice guidelines. [2][3][4][5] These negative results are closely related to the complexity of uremia, characterized by several metabolic disorders, as well as hyperparathyroidism, metabolic acidosis, Lcarnitine deficiency, and risk factors, influencing all-cause mortality. [6][7][8] General dialysis-dependent population is in fact elderly and affected by multiple co-morbid conditions, while hemodialysis (HD) represents just one component of the overall outcome-based risk profile. In particular, diabetes as well as obesity, due to their increasing incidence, are directly involved in kidney disease onset and progression. 9 Moreover, global patient heterogeneity, related to genetic, environmental, and demographic factors, needs to be evaluated as a risk factor for renal disease. Large-scale meta-analyses of genome-wide association studies have identified a number of loci significantly associated with systolic and/or diastolic blood pressure, apolipoproteins, or polymorphisms of vitamin D receptor, closely involved in the development of kidney disease. [10][11][12] Other obstacle to apply personalized dialysis is the lack of resources in the current sanitary systems, considering that, due to the combination of high costs and widespread need, renal replacement therapy is one of the most expensive treatments. 13,14 The actual costs of dialysis are not uniformly defined, with significant differences between highly resourced countries, where the most important item is the cost of nursing and medical care, and emerging countries, where the cost of dialysis supplies represents the most relevant item. 15 Moreover, ecologic implication is closely related with each HD session, analyzing water, energy, and waste

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Hemodiafiltration

Grooteman¹,

Nubé²

2017

The Essentials of Clinical Dialysis

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Medication and Hemodiafiltration

Cited by 4 publications

References 52 publications

Optimization of anti-infective dosing regimens during online haemodiafiltration

Optimization of anti-infective dosing regimens during online haemodiafiltration

Updates on hemodialysis techniques with a common denominator: The personalization of the dialytic therapy

Hemodiafiltration

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