Can Golitely (polyethylene glycol) be given to a patient with end-stage renal disease (ESRD) on hemodialysis?

Polyethylene Glycol (GoLYTELY) Use in End-Stage Renal Disease Patients on Hemodialysis

Polyethylene glycol (GoLYTELY) should not be administered to patients with end-stage renal disease on hemodialysis unless under direct supervision of a physician, as it carries a specific contraindication for kidney disease. 1

Safety Concerns in ESRD

• The FDA drug label explicitly states "DO NOT USE if you have kidney disease, except under the advice and supervision of a doctor" 1
• Patients with end-stage renal disease have impaired ability to clear medications and their metabolites, potentially leading to accumulation of substances that could cause electrolyte imbalances 2
• Unlike some medications that maintain their safety profile in ESRD (such as pantoprazole), polyethylene glycol requires special consideration due to its potential impact on fluid and electrolyte balance 3

Dosing Considerations for ESRD Patients

• For patients with end-stage renal disease on hemodialysis, medication dosing often requires adjustment based on reduced clearance 4
• Many medications require either dose reduction or increased dosing intervals in ESRD patients to prevent adverse effects 4
• If polyethylene glycol must be used for bowel preparation in an ESRD patient on hemodialysis, it should be:
  • Administered under direct physician supervision 1
  • Scheduled in relation to dialysis sessions to allow for removal of any accumulated metabolites 4
  • Monitored closely for electrolyte disturbances, particularly in the post-administration period 5

Alternative Approaches

• For ESRD patients requiring bowel preparation, consider consulting with nephrology before administration to determine:
  • Optimal timing in relation to dialysis sessions 4
  • Need for additional laboratory monitoring 5
  • Potential need for modified dosing protocols 6

Recent Evidence on PEG Formulations in CKD

• Some recent studies have examined polyethylene glycol plus ascorbic acid formulations in chronic kidney disease patients with careful monitoring:
  • A 2021 study found that conventional volume PEG with ascorbic acid may be safe in CKD patients when properly monitored, though this was not specific to ESRD patients on hemodialysis 5
  • A 2016 study suggested 2L PEG plus ascorbic acid might be safe in patients with impaired renal function, but again this was not specifically addressing ESRD patients on hemodialysis 6

Clinical Monitoring if Used

• If polyethylene glycol must be used in an ESRD patient on hemodialysis, monitor:
  • Serum electrolytes (particularly sodium, potassium, and bicarbonate) before and after administration 5
  • Fluid status and blood pressure for signs of volume depletion 2
  • Renal parameters including BUN and creatinine, though these may be less reliable in ESRD 5

Pitfalls and Caveats

• Avoid assuming that studies on CKD patients apply equally to ESRD patients on hemodialysis, as the latter group has more severe impairment of renal function 2
• Be aware that ESRD patients often have multiple comorbidities that may increase the risk of adverse effects from bowel preparation agents 2
• Remember that the FDA contraindication exists specifically to protect patients with kidney disease from potential harm 1