A female client requires hemodialysis. Which of the following drugs should be withheld before this procedure?
A. Phosphate binders
B. Insulin
C. Antibiotics
D. Cardiac glycosides
Correct Answer: D. Cardiac glycosides
Cardiac glycosides such as digoxin should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digitalis toxicity. Hyperkalemia can be a marker of severe toxicity in acute poisoning. The role of potassium is less clear in chronic toxicity, although it has been linked to higher mortality despite traditional teaching that hypokalemia worsens the dysfunction at the Na-K transporter.
Option A: Phosphate binders can be administered because they aren’t removed from the blood by dialysis. Kidneys excrete ninety percent of the daily phosphate load while the gastrointestinal tract excretes the remainder. As phosphorus is not significantly bound to albumin, most of it gets filtered at the glomerulus. Therefore, the number of functional nephrons plays a significant role in phosphorus homeostasis.
Option B: For hemodialysis patients with diabetes who refuse to take insulin at home, delivering insulin during dialysis is a good way to improve glycemic control, researchers reported at a meeting sponsored by the National Kidney Foundation.
Option C: Some antibiotics are removed by dialysis and should be administered after the procedure to ensure their therapeutic effects. The nurse should check a formulary to determine whether a particular antibiotic should be administered before or after dialysis. Patients with diabetes make up roughly half of the end-stage renal disease (ESRD) population in the United States, and good glycemic control is essential to slow the progression of both microvascular and macrovascular disease.
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