Hemodialysis Therapeutics

New pre-filled syringes of citrate4%/ethanol 30% are now available to lock HD catheters in Quebec. Have any centers outside Quebec switched from citrate4% to this new locking solution? If I am not mistaken Lavern Vercaigne has been involved in the evaluation of this product. Please reply if you have any experience or references with this locking solution.
Robert Bell
Maisonneuve-Rosemont Hospital
Montreal

Hi

What is the recomended dose of hydroxiurea in a patient on HD?

Hello RPN,

We are considering changing to s.c. Eprex in our HD patients.  I wanted to get a sense of what other units in Canada are doing.

Please let me know if you give Eprex s.c. or IV.

Thank you in advance,

Lori Wazny, Pharm.D.

Manitoba Renal Program

Hello All,

Has anyone converted their HD patients from IV Eprex to subcutaneous Eprex?  If so, did you develop a dosing table for the conversion?

I know it would be easiest to just convert to the same dose initially but most of our Eprex IV is dosed 3x/week and we don't want to be giving 3x/week subcutaneous injections to our patients.

Thank you,

Lori Wazny, Pharm.D.

Manitoba Renal Program

Hello RPN,

Is anyone using Citrasate dialysate (www.citrasate.com) for heparin-free dialysis (as danaparoid is still on backorder)?

Citrasate is now available in Canada through Chief Medical.  There are poster abstracts that this is an alternative anticoagulant in patients with high bleeding risk or HIT but haven't been able to find a publication.

Thanks,

Lori Wazny

Manitoba Renal Program

Have heard that Iron gluconate is just as safe as Iron sucrose and that it is less expensive. Is anyone using this form if IV iron in theirenal community? I am looking for any information related to the safety, efficacy and cost effectiveness of Iron gluconate.

Sheila Seeley
S.A.R.P.
Lethbridge, Alberta

I recently started working in a new center where we do Vitamin D levels, specifically, 25(OH)D3 levels. Some of the nephrologists are starting hemodialysis patients on regular plain Vitamin D 1000 IU po daily when these levels are low. They are apparently doing this based on the study that came out regarding Vitamin D reducing cancer risk (although this study was highly critisized) and also from the following paper:
25(OH)Vitamin D3 in patients with chronic kidney disease and those on dialysis: rediscovering its importance
Int Urol Nephrol (2006) 38:323-329
The later paper discusses how many other tissues in the body (other than the kidney) express 1-hydroxylase and synthesize 1,25(OH)2D3 locally. As KDOQI does not address the use of regular Vitamin D in dialysis patients, I am unsure how to interpret PTH levels and if regular Vitamin D would even affect PTH to any extent. Does anyone else have dialysis patients who take regular Vitamin D or know of any evidence for this practice? I even have some patients on both regular Vitamin D and active Vitamin D. Your input is appreciated.

If anyone is using citrate iv for IHD, would you mind contacting me (or leaving your contact info)? I would like to gather some info about your experience...
mccoyt@sah.on.ca
Thanks,
Tracy
Renal Program
Sault Ste. Marie

We reviewed the evidence regarding AMG dosing in HD patients. A few recent articles suggest administration of the AMG (e.g. tobramycin 1.5 mg/kg) at beginning rather than the end of HD to optimize Peak/MIC and AUC/MIC ratios.

Does anyone have experience with method? How do you currently dose AMG?

Piera Calissi
Saskatoon Health Region

Any experience using any antimigraine medications in the HD population? Which meds are preferred? Any recommended references? Thanks in advance for any information.