COMMONLY USED DRUGS IN HD

 Erythropoietin (EPO)
- a hormone produced by the kidney that promotes the formation of red blood
cells by the bone marrow
- Medications: Alfa (Eprex, Epokine, Epogen, Renogen, Eposino) and Beta
(Recormon)
- Indication: treatment of anemia of chronic renal failure to reduce the need for
RBC transfusions
- Not DIALYZABLE
- Target Goal: Hgb level of 9 – 12 mg/dL

 IV Iron
- Medication: Iron Sucrose (Encifer, Ferrofer, Venofer)
- Indications: treatment of iron deficiency anemia (IDA)
: given concomitantly with EPO as part of anemia management
- Mechanism of action: replaces iron stores in hemoglobin, myoglobin and enzymes
: works to transport oxygen via hgb
- Dose:
Per MD’s order: Iron sucrose 100 mg over each of the next 10 HD sessions
- NOT Dialyzable
- Target TSAT ≥ 30% and serum ferritin level of ≥ 500 ng/ml
- Iron status every 3 months during EPO therapy, monitoring response after course
of IV Iron, and blood loss
-
 Mannitol
- Medication: Mannitol 20%
- Indications: prevention of disequilibrium syndrome in new patients, used for the
first dialysis sessions
: prevent hypotension and treatment of severe cramps
 - Mechanism of action: counteracts the osmotic effect of the initially rapid removal
of urea and other solutes from plasma preventing rapid fluid shifts during initial
HD and acute increase in brain water content
- Dialyzable

 Human Albumin
- Medication: Human Albumin 25%
- Indication: used in patients with hypoalbuminemia and peripheral edema to
support excess fluid removal
- Mechanism of action: it raises the plasma oncotic pressure to mobilize fluids from
interstitial and intracellular compartments to the vascular compartments
- Given at the last 2 hours to facilitate fluid removal
- NOT Dialyzable

 Heparin
- Most widely used anticoagulant for dialysis
- Indication: prevent clotting of the extracorporeal circuit during HD
: used as lock for HD catheter lumens to keep it patent
- NOT Dialyzable
Anticoagulation for HD Clinical Condition
No anticoagulation Active bleeding
Significant risk for bleeding
Major surgery within 7 days
Intracranial surgery within 14 days
Biopsy of visceral organ within 72 hours
Pericarditis
Low dose heparin Major surgery beyond 7 days
Biopsy of visceral organ beyond 72 hours
Minor surgery 8 hours prior
Minor surgery within 72 hours
Low dose heparin or no anticoagulation Major surgery 8 hours prior

 Normal Saline 0.9% (PNSS)

- Indication: Priming dialysis line
: rinse back solution
: 1st line treatment of hypotension
: treatment of muscle cramps
- Dialyzable
- Dose: 100 – 200 mL

 Dextrose 50% (D50-50)

- Indication: treat and prevent hypoglycemia in diabetic patients
: prevent severe cramps during HD (25 – 50 mL)
- Dialyzable