Abstract
The serum protein binding of representative cephems (CPM, CET, LMOX) was assessed during and after hemodialysis (HD) with heparin, low molecular heparin or nafamostat as the anticoagulant.
Using heparin or low molecular heparin, the protein binding of CPM and LMOX decreased at the end of dialysis and then returned to the predialysis value. The protein binding of CET showed the opposite change. The protein binding of CPM and LMOX correlated inversely with non-esterified fatty acids (NEFA), while those of CET correlated directly with NEFA. On the other hand, using nafamostat, the protein binding of CPM, CET and LMOX showed no change during or after HD. Changes in the protein binding of CPM, CET and LMOX during and after HD may be the result from the increment of NEFA through heparin and low molecular heparin-induced lipase activation. The protein binding of cephems after HD depends on the types of cephems and anticoagulants used, which significantly impacts on their pharmacokinetics.
In conclusion, changes in the protein binding of cephems should be taken into consideration when these drugs are administered after HD.
