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Kidney Week

Abstract: SA-PO665

A Proof-of-Concept Study: Metoprolol Tartrate Is Readily Cleared by Peritoneal Dialysis

Session Information

  • Home Dialysis - II
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Helvaci, Ozant, Gazi Universitesi Tip Fakultesi, Ankara, Ankara, Turkey
  • Topuz, Dolunay Merve, Gazi Universitesi Eczacilik Fakultesi, Ankara, Ankara, Turkey
  • Yasar, Emre, Gazi Universitesi Tip Fakultesi, Ankara, Ankara, Turkey
  • Yildirim, Saliha, Gazi Universitesi Tip Fakultesi, Ankara, Ankara, Turkey
  • Guz, Galip, Gazi Universitesi Tip Fakultesi, Ankara, Ankara, Turkey
  • Akaydin, Sevgi, Gazi Universitesi Eczacilik Fakultesi, Ankara, Ankara, Turkey
Background

The dialyzability of cardioprotective β-blockers such as metoprolol and carvedilol is well-known. Even so, there is no consensus on the choice between metoprolol vs. carvedilol due to studies with conflicting results. The situation is worse for PD patients since the data on PD clearance of β-blockers is far more scarce. Furthermore, some authors have linked β-blockers to UF failure without a clear mechanism.

In this proof-of-concept study, we aimed to develop a technique for determining the metoprolol tartrate (MT) level in the effluent and serum samples of PD patients. The completed version of the study will also include metoprolol succinate and carvedilol levels, which we expect to be the first study to investigate that phenomenon.

Methods

We selected nine patients on stable doses of MT aimed at a resting pulse<70/min. All predialysis samples were taken on the dry abdomen. Regardless of APD or CAPD status, an exchange with 1.36% glucose solution was done. After a 2-hour dwell time, post-dialysis blood samples and effluent samples were collected. In addition, pre and post-pulses and ECGs were recorded.
The blood samples were analyzed with the HPLC 1220 ® (High-performance liquid chromatography) instrument. The peaks at 262 nm were recorded, and the AUC values were calculated based on the standard analysis. A similar process was followed for the effluent.

Results

The mean age was 58±11 years. Drug doses and baseline pulse rates were similar. The mean pre-PD MT levels were 134±66 ng/mL, and post-PD levels were 51±28 ng/mL. The average effluent drug concentration was 81±51 ng/mL, and the delta change between pre-post dialysis was 60±11%.
Patients on APD had numerically higher MT baseline and post-dialysis concentrations, but the difference was insignificant (p=0,190). Residual renal function and transporter types did not affect drug levels.
Pre and post-dialysis pulse rates were statistically similar; no tachycardia event was observed.

Conclusion

We have shown that effluent has very high levels of MT. This might be the link to the so-called β-blocker-related UF failure. Furthermore, we have proven that PD readily clears MT.
After the completion of the study with the addition of metoprolol succinate and carvedilol levels, we hope to facilitate the "β-blocker" debate in the field of peritoneal dialysis.