Dialysis is a life-sustaining treatment for individuals with kidney failure, replacing essential kidney functions. Careful medication management is a fundamental aspect of care for these patients. Precise adjustments are tailored to each medication and the patient’s unique health situation.
Understanding Medication Management Around Dialysis
Medication management before dialysis is important because of how dialysis interacts with drugs. Dialysis filters waste and excess fluids, but can also inadvertently remove certain medications. If not properly adjusted, this removal can lead to lower drug levels, making medication less effective.
Conversely, medications not efficiently removed by dialysis can accumulate due to impaired kidney function. This accumulation can lead to high drug concentrations and increased side effects. Understanding how the body processes a drug (pharmacokinetics) is central to determining appropriate dosing and timing around dialysis sessions.
Medications Typically Held Before Dialysis
Certain medications are held before dialysis to prevent complications. Blood pressure medications, such as ACE inhibitors and ARBs, are often withheld to avoid a significant drop in blood pressure during or after dialysis. This helps prevent intradialytic hypotension.
Some antibiotics are held before dialysis, as the treatment can remove them. To maintain therapeutic levels, these medications are administered after the session. Water-soluble vitamins, including B and C, are often removed by dialysis. These are replaced after the session to prevent deficiencies.
Medications Typically Continued Before Dialysis
Conversely, some medications are continued before dialysis because they are not significantly removed or are essential for immediate health. Insulin is continued, often with dose adjustments to prevent low blood sugar during or after treatment. Patients may need a 10-15% reduction in their basal insulin dose on dialysis days.
Phosphate binders are continued, as they prevent dietary phosphorus absorption. These should be taken with meals, regardless of the dialysis schedule, to be effective. Many cardiac medications, such as certain beta-blockers, are continued if not significantly dialyzable or critical for heart function. Thyroid hormones are continued, as dialysis does not significantly alter their levels or the body’s need.
Why Personalized Guidance is Essential
The information provided serves as general guidance, but every patient’s medication regimen must be individualized. Factors contributing to this personalization include the patient’s specific health conditions, the type of dialysis, and how their body responds to medications. Healthcare providers develop treatment plans considering these characteristics to optimize outcomes.
Consulting the healthcare team (nephrologist, dialysis nurse, pharmacist) is paramount. They assess all concurrent medications and provide precise instructions. Adjusting doses without professional guidance can lead to ineffective treatment or dangerous side effects.