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Choosing the right chronic medication for hemodialysis patients. A short ABC for the dialysis nephrologist

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Abstract

Background

Adapting drug treatments for patients on hemodialysis with multiple chronic pathologies is a complex affair. When prescribing a medication, the risk–benefit analysis usually focuses primarily on the indication of the drug class prescribed. However, the pharmacokinetics of the chosen drug should also be taken into account. The purpose of our review was to identify the drugs to be favored in each therapeutic class, according to their safety and pharmacokinetic profiles, for the most common chronic diseases in patients on chronic hemodialysis.

Methods

We conducted a narrative review of the literature using Medline and Web of Science databases, targeting studies on the most commonly-prescribed drugs for non-communicable diseases in patients on chronic hemodialysis.

Results

The search identified 1224 articles, 95 of which were further analyzed. The main classes of drugs included concern the cardiovascular system (anti-hypertensives, anti-arrhythmics, anti-thrombotics, hypocholesterolemics), the endocrine and metabolic pathways (anti-diabetics, gastric anti-secretory, anticoagulant, thyroid hormones, anti-gout) and psychiatric and neurological disorders (antidepressants, anxiolytics, antipsychotics and anti-epileptics).

Conclusion

We report on the most often prescribed drugs for chronic pathologies in patients on chronic hemodialysis. Most of them require adaptation, and in some cases one better alternative stands out among the drug class. More pharmacokinetic data are needed to define the pharmacokinetics in the various dialysis techniques.

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Acknowledgements

The authors wish to thank Nîmes University Hospital, France, for its structural, human, and financial support through the award obtained by our team during the internal call for tenders “Thématiques émergentes” (emerging themes). We also thank Teresa Sawyers, Medical Writer at the BESPIM, Nîmes University Hospital, France, for her expertise in reviewing and editing this paper.

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Authors and Affiliations

  1. Service Pharmacie, Hopital Universitaire de Nimes, CHU Carémeau, Nîmes, France

    Clarisse Roux & Kristelle Verollet

  2. Institut Desbrest d’Epidemiologie et Santé publique (IDESP), INSERM, Montpellier, France

    Clarisse Roux, Julien Prouvot & Olivier Moranne

  3. Service Néphrologie Dialyse Apherese, Hopital Universitaire de Nimes, CHU Carémeau, Nîmes, France

    Julien Prouvot, Camelia Prelipcean, Emilie Pambrun & Olivier Moranne

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  1. Clarisse Roux
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Correspondence to Clarisse Roux or Olivier Moranne.

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Roux, C., Verollet, K., Prouvot, J. et al. Choosing the right chronic medication for hemodialysis patients. A short ABC for the dialysis nephrologist. J Nephrol 36, 521–536 (2023). https://doi.org/10.1007/s40620-022-01477-9

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