Drug Dosing Considerations in Alternative Hemodialysis

The provision of renal replacement therapy for patients with chronic kidney disease has been reasonably standardized for decades, with thrice-weekly hemodialysis being the standard. Short-daily and nocturnal hemodialysis are 2 new hemodialysis techniques, each are administered 6 to 7 days a week but differ primarily in the duration of the treatment and blood-flow rate. The emergence of these hemodialysis regimens has shown promise in attenuating some of the complications associated with chronic kidney disease. The benefits of these daily regimens are postulated to be a result of enhanced solute clearance and improved extracellular volume management. The improved solute clearance associated with daily hemodialysis is likely to lead to altered dialytic clearance of drugs given to patients receiving these therapies. The purpose of this paper is to review the concepts pertinent to drug removal by hemodialysis and discuss the issues related to these new dialysis techniques and how they may have a impact on drug removal and the design of dosing regimens.