EVALUATION OF RENAL DRUG DOSING IN HOSPITALIZED PATIENTS WITH RENAL IMPAIRMENT


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Memiş H., Çakır A., Güzel S., Özdemir N., Gün Z. Ü.

13th International Symposium on Pharmaceutical Sciences, Ankara, Turkey, 22 - 25 June 2021, pp.211

  • Publication Type: Conference Paper / Summary Text
  • City: Ankara
  • Country: Turkey
  • Page Numbers: pp.211
  • Inonu University Affiliated: Yes

Abstract

Introduction: Drug-related problems (DRPs) are an undesirable patient experience that involves drug therapy and actually or potentially interferes with the desired patient outcome (1). Dose-related errors are common DRPs in patients with renal impairment that require close follow-up and dose adjustment according to renal functions (2). In this study, it was aimed to evaluate the appropriateness of drug doses in nephrology inpatient clinic according to patients’ renal functions.

Materials and Methods: This point prevalence cross-sectional study was conducted in the adult nephrology clinic of a tertiary care hospital. Inpatients on the day of the point prevalence (30th April 2021) were included in the study. All orders prescribed during the patients' hospitalization period at the nephrology clinic were retrospectively reviewed by 3 clinical pharmacists. Lexicomp UpToDate® and Rx Media Pharma® were used in the evaluation of drugs’ doses. The creatinine clearance was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. To summarize the characteristics of the data, descriptive statistics were used.

Results: The data of 22 patients, 9 (40.9%) male, and 13 (59.1%) female, with a mean age of 57.95±14.40 years, were analyzed. The proportion of chronic kidney disease, acute kidney disease, and hyponatremia was respectively 52%, 16%, and 16%. Seven patients were on dialysis; 2 (28.57%) of them were peritoneal dialysis and 5 (71.43%) of them were hemodialysis. The mean number of chronic diseases per patient was 2,09±1.35 and the patients’ mean length of stay was 12±8.81 days. Fifty-eight drugs were required dose adjustment according to patients’ renal functions. Fourteen (24.14%) drugs’ dose was not appropriate in terms of the patients’ estimated glomerular filtration rate values. The pharmacological groups of drugs requiring dose adjustment were antimicrobials (42.85%), anticoagulants (21.42%), antihyperuricemics (14.28%), and others (21.45%). It was found that most of the antimicrobial requiring dose adjustment was cefazolin (33.33%). While vancomycin (16.67%) required an increase in the dose, tenofovir alafenamide (16.67%) required discontinuation and other antimicrobials required dose reduction.

Conclusions: In this study, the highest dose error was encountered in antimicrobial drugs. In patients with reduced kidney function, dose adjustment of certain drugs is necessary to prevent toxicity and to provide an effective treatment. The involvement of the clinical pharmacist in the multidisciplinary team in nephrology clinics will contribute to the detection and prevention of DRPs.