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Artificial kidneys and clearance calculations

T P Gibson, E Matusik, L D Nelson

    Clinical Pharmacology and Therapeutics
    |December 1, 1976
    PubMed
    Summary
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    Artificial kidneys remove procainamide (PA) and N-acetylprocainamide (NAPA) from blood. Clearance calculations indicate these drugs are removed from red blood cells, not just plasma.

    Area of Science:

    • Nephrology
    • Pharmacokinetics
    • Artificial Organ Technology

    Background:

    • Artificial kidneys (dialysis) are crucial for solute removal in patients with renal failure.
    • Accurate clearance calculations are essential for optimizing drug removal during dialysis.
    • Understanding drug removal kinetics, including red blood cell partitioning, is vital for therapeutic drug monitoring.

    Purpose of the Study:

    • To determine the in vivo and in vitro clearance of procainamide (PA) and N-acetylprocainamide (NAPA) using artificial kidneys.
    • To compare different methods of calculating solute clearance during dialysis.
    • To investigate the extent to which PA and NAPA are removed from red blood cells during dialysis.

    Main Methods:

    • In vivo clearance of PA and NAPA was measured in 4 patients undergoing dialysis.

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  • Calculations utilized plasma flow, whole blood flow, plasma solute concentration, and total solute removed.
  • In vitro clearance was assessed using 11 artificial kidneys and an XAD-4 hemoperfusion column for PA, NAPA, quinidine, and phenobarbital.

    • Main Results:

    • In vivo clearance calculated using total amount recovered was generally higher than methods relying solely on plasma concentration.
    • Clearance determined by total amount recovered was substantially greater than that using plasma flow and plasma levels.
    • In vitro studies revealed significant differences in clearance rates among various artificial kidneys and the hemoperfusion column.

    Conclusions:

    • Both procainamide (PA) and N-acetylprocainamide (NAPA) are removed from red blood cells, in addition to plasma, during dialysis.
    • Calculating clearance based on the total amount of solute recovered provides a more comprehensive assessment of drug removal.
    • Significant variability exists in the solute removal efficiency of different artificial kidney devices.