Decreased quinidine plasma protein binding during hemodialysis

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Abstract
Quinidine binding to serum proteins was quantitated in 10 regularly dialyzed patients with end-stage renal disease, both under baseline conditions and after heparin during a single hemodialysis. Quinidine binding was determined in vitro, after the addition of 2 .mu.g/ml quinidine sulfate, by ultrafiltration combined with spectrophotofluorometry. The baseline percent unbound quinidine concentration in patients was 6.5 .+-. 2.3% (mean .+-. SD), a value lower than in normal subjects (9.9 .+-. 3.0%, n = 18, P < 0.005). Binding correlated with both serum albumin (r = 0.72, P < 0.02) and free fatty acid (r - 0.65, P < 0.05) concentrations. After heparin there was a rise in percent unbound quinidine (12.2 .+-. 5.6%, P < 0.025) and in free fatty acid concentration (1111 .+-. 1202 .mu.eq/l, P = 0.004) in each subject. After heparin the relationship between quinidine binding and free fatty acid concentration was again evident (r = 0.97, P < 0.001). Dynamic changes in the levels of free quinidine, and other drugs during hemodialysis, may require adjustments to avoid toxicity and adverse interactions.

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