Medication Management and Timing Around Dialysis Sessions: A Practical Guide for Nursing Home Staff

For nursing home residents with End-Stage Renal Disease (ESRD), effective medication management is about more than just ensuring pills are passed on time, it’s about timing them right. Dialysis profoundly alters how medications behave in the body, and failure to coordinate medications with dialysis schedules can lead to dangerous side effects or reduced treatment effectiveness.

This guide will help your nursing home team understand why timing matters, which medications are affected, and how to work collaboratively with dialysis providers to ensure resident safety and wellbeing.

Why Dialysis Affects Medication Timing

Dialysis removes waste products and excess fluids, but it can also remove certain medications. Depending on a drug’s molecular size, protein binding, and volume of distribution, some are filtered out during treatment while others are unaffected.

Dialysis can also:

• Alter how medications are absorbed and metabolized.
• Accelerate or delay drug clearance.
• Cause blood pressure fluctuations that interact poorly with certain medications (e.g., antihypertensives).

Because of this, medication timing and dosage must be carefully adjusted based on the dialysis schedule and resident-specific factors.

Common Medication Timing Considerations

• Problem: Residents often experience low blood pressure during or after dialysis.
• Best Practice: Many providers recommend withholding blood pressure medications on dialysis days until after treatment, unless the physician indicates otherwise.

• Problem: Many antibiotics (like vancomycin or aminoglycosides) are removed during dialysis, especially with high-flux filters.
• Best Practice: Coordinate with dialysis staff or pharmacy to administer antibiotics after dialysis or use dosing that accounts for removal rates.

• Problem: These medications work best when taken with meals, not based on dialysis timing.
• Best Practice: Ensure they are administered with meals, even on dialysis days, unless the resident is NPO.

• Best Practice: Often administered during or immediately after dialysis, depending on facility preference. Communication is key to avoid duplicate dosing.

• Problem: These are easily removed by dialysis.
• Best Practice: Administer after dialysis sessions to ensure residents retain needed nutrients.

Strategies for Safe and Effective Medication Management

Maintain a separate list or flag in your EMR for medications that need adjusted timing on dialysis days. This makes it easier for med passers to avoid errors.

Hold regular medication review meetings that include your consultant pharmacist, nursing leadership, and (if possible) a representative from the dialysis facility. These reviews should focus on:

• New prescriptions or dose changes
• Missed dialysis sessions
• Adverse reactions

Conduct in-services to educate nursing staff and med techs about which medications require timing modifications and the reasons behind them. This helps promote critical thinking and proactive communication.

Maintain a communication notebook, shared folder, or secure digital form for dialysis staff to leave notes about:

• Post-dialysis observations (e.g., fatigue, hypotension)
• Access site concerns
• Recommendations regarding medication timing or changes

If a medication is held due to dialysis timing, document it properly using your facility’s preferred method (e.g., “held per MD order due to dialysis”). This protects both staff and residents from confusion and ensures compliance with regulations.

Resident and Family Education

Residents and their families may not always understand why medications are delayed or changed around dialysis. Educate them by:

• Providing clear, simple explanations (e.g., “This medication works better if we wait until after your treatment.”)
• Reassuring them that decisions are made collaboratively with medical providers
• Encouraging questions and discussions during care plan meetings

Resources from Qsource

Qsource’s ESRD Network offers helpful resources for improving medication safety and care coordination across dialysis settings. Visit esrd.qsource.org to access the materials and explore training opportunities for your staff.