When do (or don't) you administer drugs to patients on hemodialysis?
E. James Ryan BSN, RN, CDN

August 2012 
Volume 42  Number 8
Pages 47 - 49
  PDF Version Available!

HEMODIALYSIS (HD) REPLACES some of the basic functions of healthy kidneys such as removing excess fluid and filtering waste products. Because of this filtering effect, special considerations are needed when patients on HD are taking certain medications, including antihypertensive drugs and antibiotics. This article reviews when you should or shouldn't administer these drugs. Even with multiple comorbidities, patients in renal failure can enjoy a high quality of life, and you play a key role through safe and effective medication administration.One of the kidneys' functions is to maintain a proper balance of calcium and phosphorus (see Functions of the kidney). Complications that can occur when a patient has chronic kidney disease (CKD) include fluid and electrolyte imbalances, acid-base imbalances, bone disease (disorders of mineral metabolism), cardiovascular problems, disorders associated with an accumulation of nitrogenous waste products, anemia and coagulation disorders, and impaired drug elimination (see Complications of CKD).1 A patient with CKD will most likely be taking drugs to treat these complications, such as antihypertensives and phosphate binders.When a patient has CKD, abnormalities in calcium and phosphorus metabolism occur because of impaired phosphate elimination and vitamin D activation (see Balancing act).1 The most effective treatment for a calcium and phosphorus imbalance related to CKD is the use of phosphate binders (such as calcium carbonate, sevelamer carbonate, or lanthanum carbonate) and dietary modifications such as a low-phosphorus diet.Phosphate binders reduce the amount of phosphorus that's absorbed from food. This interaction of binder and food occurs in the gastrointestinal tract. So to be effective, binders must be taken with all meals and even snacks.2 For patients on HD, hold phosphate binders only if they're not eating or are hypercalcemic.Although coordinating a patient's phosphate binder with meals can be difficult, it's critically

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