Plasma levels and effects of sulfinpyrazone in patients requiring chronic hemodialysis

Clearance of cardiovascular medications during hemodialysis

PURPOSE OF REVIEW

To review the current understanding of hemodialysis-mediated clearance of commonly used cardiovascular medications.

RECENT FINDINGS

Although cardiovascular drug dialyzability is poorly understood, many drug classes appear to include agents with substantially different degrees of dialyzability. Recent data suggest that more readily dialyzable beta-blockers associate with higher short-term mortality in patients initiating these drugs when on hemodialysis. Although this relationship was not observed in a later study with angiotensin-converting enzyme inhibitors of varying dialyzability, studies of this kind are currently limited by pharmacokinetic data that are either incomplete or no longer applicable to modern hemodialysis procedures.

SUMMARY

There are substantial deficits in our understanding of cardiovascular medication dialyzability, which relates in large part to advances in the process of hemodialysis that have rendered older studies of dialyzability irrelevant. The importance of cardiovascular disease in patients receiving hemodialysis demands a better understanding of the effect hemodialysis exerts on cardiovascular drug pharmacokinetics.

Effect of sulfinpyrazone upon antithrombin III and platelet factor 4 in chronic renal failure

Despite the suppressive effects of uremia upon platelet function, patients with chronic renal failure are at increased risk for thrombotic diseases. This increased risk is linked to lowered concentrations of antithrombin III (AT III) and increased platelet release in vivo, as indicated by increased plasma concentrations of platelet factor 4 (PF4). Sulfinpyrazone, a drug capable of reducing the frequency of thrombotic events in uremic patients, allows return toward normal of the AT III while reducing to normal the plasma concentration of PF4. Thus, suppression of platelet function by sulfinpyrazone appears to reduce in vivo clotting, and thus reduces consumption of AT III.