Clinical pharmacokinetics during continuous ambulatory peritoneal dialysis

Peritoneal dialysis (PD) has gained recognition worldwide as an alternative to haemodialysis in the management of patients with end-stage renal disease. Because the peritoneal catheter provides direct access to the peritoneum, intraperitoneal drug administration has become widely used for the administration of certain drugs. The instillation and drainage of PD fluids contribute to the total body clearance of drugs given by other routes. For most drugs, peritoneal clearance is low. This paper provides an updated review of recently published pharmacokinetic studies involving the administration of selected drugs to patients receiving PD. Antibiotics continue to be extensively studied and administered in PD patients because of the frequent occurrence of infections. Epoetin (recombinant human erythropoietin) has become widely used and is the subject of ongoing pharmacokinetic investigation. Intraperitoneal insulin has become accepted for the treatment of patients with diabetes receiving PD; the pharmacokinetics of vitamin D analogues in PD patients continue to be explored.