Comparative Pharmacokinetics of Theophylline in Peritoneal Dialysis and Hemodialysis

Abstract

Dialysis clearance and drug recovery of theophylline were investigated in three peritoneal dialysis patients and the results were compared with those obtained from five hemodialysis patients. Peritoneal clearance averaged 9.5 ml/min, in contrast with the hemodialysis clearance of 84.8 ml/min, indicating a relative inefficiency of peritoneal dialysis with regard to theophylline removal. Theophylline half-life was reduced substantially during hemodialysis, 2.0 to 3.2 hours, in comparison with the normal half-life range of 4.7 to 6.8 hours during peritoneal dialysis. The fraction of theophylline recovered by peritoneal dialysis approximated 3.2 per cent of dose, while hemodialysis recovered up to 40 per cent of the administered dose. The overall observations of half-life, dialysis clearance, and drug recovery suggest a clear advantage of hemodialysis over peritoneal dialysis for theophylline detoxification. However, peritoneal dialysis may be preferred to hemodialysis for uremic patients requiring theophylline therapy. Since the removal of theophylline by peritoneal dialysis is minimal, an undesirable alteration of the theophylline dosage regimen in association with dialysis therapy can thus be avoided.

Clinical toxicology

“…Lee et al 73 reported similar values (9.5 ml/minute). Thus, peritoneal dialysis is much less effective than haemodialysis which can achieve clearances of 112 ml/minute74 in adults, if blood flow is maintained.…”

Available Extracorporeal Treatments for Poisoning: Overview and Limitations

“…The use of peritoneal dialysis (PD) is infrequent in poisoning, due to its limited clearance capacity . The overall clearances are much lower with PD than other techniques.…”

“…The overall clearances are much lower with PD than other techniques. For example, clearances for theophylline are 10 ml/minute with PD compared to 85 ml/minute with IHD .…”

Principles and Operational Parameters to Optimize Poison Removal with Extracorporeal Treatments

“…Peritoneal dialysis (PD) also uses the principle of passive diffusion, although fluid and solute exchange occurs in the peritoneal cavity across the peritoneal membrane. The use of PD in poisoning has almost disappeared due to its limited clearance capacity compared with IHD . In PD, increasing the dialysate flow rate ( Q D ) maximizes clearance.…”