AUTOMATED PERITONEAL-DIALYSIS - NEW IMPLICATIONS FOR PHARMACISTS

OBJECTIVE: TO review the new automated peritoneal dialysis (APD) modal ities that are available to patients with end-stage renal disease (ESR D), and to examine their potential pharmacokinetic and drug dosing con sequences. DATA SOURCES: A MEDLINE search (from January 1966 to June 1 996) of English-language literature pertaining to peritoneal dialysis was performed. Additional references were obtained by reviewing the re ferences of pertinent articles identified through the search. Tertiary sources were also used. DATA EXTRACTION: Data regarding peritoneal di alysis techniques and pharmacokinetics were extracted from the literat ure. Data were evaluated according to the study design, population, re sults, and conclusions. DATA SYNTHESIS: ESRD is the result of progress ive chronic renal insufficiency and requires renal replacement therapy . APD is the fastest growing renal replacement therapy by percentage i n the US and provides dialysis exchanges via a machine while the patie nt sleeps, thereby improving patient convenience, peritoneal dialysis compliance rates, and decreasing peritonitis rates. Well-designed phar macokinetic studies involving APD have not been conducted. Consequentl y, no formal drug dosing recommendations are available for APD, and ph armacists must rely on established dosing guidelines for continuous am bulatory peritoneal dialysis (CAPD) when recommending dosing regimens. This article describes the new APD treatment modalities available and the potential pharmacokinetic differences between CAPD and APD. CONCL USIONS: Well-designed studies are needed to fully characterize the pha rmacokinetic parameters of drugs in APD. Until then, pharmacists shoul d recommend that intraperitoneally administered drugs be given during the longest peritoneal dialysate dwell of the day and that serum conce ntrations of drugs with narrow therapeutic indices be monitored closel y.