Dialysis is a process whereby substances

move via a concentration gradient across

a semipermeable membrane
Substances that are small enough to pass
through the pores in the semipermeable
membrane will pass out of the blood into
the dialysis fluid. Once in the dialysis
fluid, waste products and other
compounds can be removed from the
body.
Because drugs can be removed by
dialysis, it is important to understand
when drug dosing needs to be modified in
renal failure patients undergoing the
procedure.
Drug Characteristics that Effect Dialysis
Removal

MOLECU
LAR SIZE

VOLUME WATER/L
OF IPID
DISTRIBU SOLUBILI
TION TY

PLASMA
PROTEIN
BINDING
 Drug Characteristics that Effect Dialysis
Removal

MOLECULAR SIZE
Drug molecules with moderate molecular weights (molecular
weight 5001000 Da, such as aminoglycoside antibiotics [~400500
Da] and digoxin) have a decreased ability to pass through the
semipermeable membrane contained in low-flux filters. However,
many drugs that fall in this intermediate category have sufficient
dialysis clearances to require postdialysis replacement doses. Large
drug molecules (molecular weight >1000 Da, such as vancomycin) are
not removed to a significant extent when low-flux filters are used for
dialysis because pore sizes in these artificial kidneys are too small for
the molecules to fit through. However, many large molecular weight
drugs can be removed by dialysis when high-flux filters are used, and,
in some of these cases, supplemental postdialysis drug doses will be
needed to maintain therapeutic amounts of drug in the body.
 WATER/LIPID SOLUBILITY
Drugs that have a high degree of water solubility
will tend to partition into the waterbased dialysis fluid,
while lipid-soluble drugs tend to remain in the blood.
PLASMA PROTEIN BINDING
Drugs that are highly bound to plasma proteins
have low free fractions of drug in the blood and poor
dialysis clearance rates.
 VOLUME OF DISTRIBUTION
Medications with large volumes of distribution are
principally located at tissue binding sites and not in the
blood where dialysis can remove the drug. Because of this,
agents with large volumes of distribution are not easily
removed from the body. In fact, some compounds such as
digoxin, have good hemodialysis clearance rates, and drug
contained in the bloodstream is very effectively eliminated.
However, in this case the majority of the drug is present in
the tissues and only a small amount of the total drug
present in the body is removed.