A survey on the appropriateness of drug therapy in patients with renal dysfunction at the Internal Medicine Ward FMUI/Dr. Cipto Mangunkusumo Hospital

Soetikno, Vivian; Effendi, Imam; Nafrialdi, Nafrialdi; Setiabudy, Rianto

doi:10.13181/mji.v18i2.348

Cited by 6 publications

(7 citation statements)

References 19 publications

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“…In marked contrast, the same percentage of medication dosing errors in Pakistan was comparatively higher than the studies reported from Bosnia and Herzegovina, Australia, France, Saudi Arabia, Indonesia, and even Nepal, whereby the percentages of unadjusted drugs were nearly 52.6%, 44.8%, 34.0%, 53.1%, 20.0%, and 13.5% respectively [ 7 , 8 , 12 , 18 , 30 , 31 ]. This clearly reflects that Pakistani physicians are lacking knowledge as compared to those in the developed countries [ 32 ].…”

Section: Discussionmentioning

confidence: 67%

Pattern and Predictors of Medication Dosing Errors in Chronic Kidney Disease Patients in Pakistan: A Single Center Retrospective Analysis

Saleem

Masood

2016

PLoS ONE

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BackgroundChronic kidney disease (CKD) alters the pharmacokinetic and pharmacodynamic response of various drugs and increases the risk of toxicity. The data regarding the pattern and predictors of medication dosing errors is scare from the developing countries. Therefore, the present study was conducted to assess the pattern and predictors of medication dosing errors in CKD patients in a tertiary care setting in Pakistan.MethodsA retrospective study design was employed and medical charts of all those CKD patients who had an eGFR ≤60ml/min/1.73m2, hospitalization ≥24 hours, and admitted in the nephrology unit during January 2013 to December 2014 were assessed. Descriptive statistics and the logistic regression analysis were done using IBM SPSS version 20.ResultsIn total, 205 medical charts were assessed. The mean age of patients was 38.64 (±16.82) years. Overall, 1534 drugs were prescribed to CKD patients, of which, nearly 34.0% drugs required dose adjustment. Among those drugs, only 41.8% were properly adjusted, and the remaining 58.2% were unadjusted. The logistic regression analysis revealed that the medication dosing errors were significantly associated with the CKD stages, i.e. stage 4 (OR 0.054; 95% CI [0.017–0.177]; p <0.001) and stage 5 (OR 0.098; 95% CI [0.040–0.241]; p <0.001), the number of prescribed medicines ≥ 5 (OR 0.306; 95% CI [0.133–0.704]; p 0.005), and the presence of a comorbidity (OR 0.455; 95% CI [0.226–0.916]; p 0.027) such as the hypertension (OR 0.453; 95% CI [0.231–0.887]; p 0.021).ConclusionsIt is concluded that more than half drugs prescribed to CKD patients requiring dose adjustment were unadjusted. The predictors of medication dosing errors were the severe-to-end stages of chronic kidney disease, the presence of a comorbidity such as hypertension, and a higher number of prescribed medicines. Therefore, attention should be paid to these risk factors.

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Section: Discussionmentioning

confidence: 67%

Pattern and Predictors of Medication Dosing Errors in Chronic Kidney Disease Patients in Pakistan: A Single Center Retrospective Analysis

Saleem

Masood

2016

PLoS ONE

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“…Same result is seen in Soetikno, et al . [18] done in Indonesia and Sweileh, et al . [16] done in Palestine.…”

Section: Discussionmentioning

confidence: 99%

Appropriateness of drug dose and frequency in patients with renal dysfunction in a tertiary care hospital: A cross-sectional study

Prajapati

Ganguly

2013

J Pharm Bioall Sci

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AIM:Study was aimed to assess the accuracy of drug dose and its frequency in patients with renal dysfunction in a tertiary care hospital.MATERIALS AND METHODS:This was a retrospective observational study. Patients > 18 years old, with the serum creatinine (SCr) level > 1.4 mg/dl were included. Drugs prescribed to these patients were recorded in case record form. Drugs for which the dose was adjusted according to the clinical response to therapy, not according to SCr level (i.e., angiotensin converting enzyme inhibitors, diuretics, B blockers, anti-diabetics, etc.) were not taken into consideration. Based on the creatinine clearance which was calculated by Cockroft-Gault formula, dose and frequency of prescribed drugs were assessed using “Drug prescribing in renal failure – dosing guidelines for adults, 4th edition” and by another literature. Data was analyzed using Statistical Product and Service Solutions by IBM corporation version 17.0 software.RESULTS:Total 278 indoor patients were screened, out of which 205 patients included. Total drugs prescribed to the patients were 1338 with the average of 6.53 drugs per patient. Out of these 180 (13.45%) drugs needed dose adjustment. Among them only 34 (18.89%) drugs were adjusted appropriately, and rest 146 (81.11%) were not adjusted. The most common group of drug that need dose adjustment was anti-microbials (144, 80%) with levofloxacin as individual drug.CONCLUSION:This study emphasizes the importance of patients with renal dysfunction and implementing appropriate dose adjustments. This study also suggests intervention such as on-line information to assist dose guidelines and participation of clinical pharmacologist could improve patient outcome.

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“…In contrast to our study the result of medication dosing error was higher than even less developed countries such as Indonesia and Nepal where the unadjusted drugs percentage were 20.0% and 13.5% respectively. 29,32 The proportion of dosing error in our study was also greater than the studies conducted in Saudi Arabia, Australia and France which is 53.1%, 44.8% and 34.0%, respectively. 17,30,31 This suggests that either the physician’s knowledge is inadequate or the clinical pharmacy services in our setting are lacking, compared to developed states.…”

Section: Discussionmentioning

confidence: 39%

“…CKD patients are the high-risk population for drug related problems, and among them, medication dosing errors are the most prevalent in these patients. 7,27,28 A large number of published studies 7,15,19,[27][28][29][30][31][32][33][34] have determined the medication dosing error in these patients, but unfortunately, few to none published studies were, to our knowledge, conducted in this part of the region.…”

Section: Discussionmentioning

confidence: 99%

Assessment of medication Dosage Adjustment in Hospitalized Patients with Chronic Kidney Disease

Hassan

Ali

Ullah

et al. 2020

Preprint

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Inappropriate medication dosing can develop adverse drug reactions (ADRs) or ineffective therapy due to declined renal function in patients with renal insufficiency.This necessitates proper renal dose adjustment.Using a retrospective analysis of medical records, this study was proposed to evaluate medication dosage adjustment in hospitalized chronic kidney disease (CKD) patients. This retrospective review of medical records was conducted at the Institute of Kidney Disease (IKD) Peshawar. It included all CKD patients hospitalized between May 01, 2019 and April 25, 2020. Glomerular filtration rate was calculated using Modification of Diet in Renal Disease (MDRD) formula and dose appropriateness was established by evaluating practice with relevant reference books. Of the total 1537 CKD patients, 231(15.03%) had evidence of dosing error, which were considered for final analysis. Overall, 1549 drugs were prescribed, 480(30.99%) drugs required dose adjustment of which 196(40.42%) were adjusted properly and the remaining 286(59.58%) were unadjusted. The most common unadjusted drugs were meropenem, cefepime, ciprofloxacin and rosuvastatin, whereas captopril, aspirin, bisoprolol, pregabalin and levofloxacin had the highest percentage of adjusted drugs. On multivariate logistic regression, the number of drugs requiring dosing adjustments and obstructive nephropathy were found to be statistically significant factors that increased the likelihood of the medication dosing errors, A unit increase in the number of drugs requiring dose adjustment increases 5.241 times the likelihood of dosing error. Similarly the presence of obstructive nephropathy (OR 0.383, 95% Cl [0.153-0.960] P= 0.041) was found to be significantly associated with dosing error after adjustment for potential confounding factors. The dosing of more than half of the prescribed drugs that required adjustment in CKD patients were not adjusted which showed that medication dosing errors were high. This highlights the importance of medication prescription according to guidelines in these patients to improve the outcomes of pharmacotherapy and patients quality of life.

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A survey on the appropriateness of drug therapy in patients with renal dysfunction at the Internal Medicine Ward FMUI/Dr. Cipto Mangunkusumo Hospital

Abstract: Tujuan Penyesuaian dosis dan pemilihan jenis obat penting dilakukan dalam keadaan gangguan fungsi ginjal. Penelitian observasional ini bertujuan untuk mengetahui ketepatan penyesuaian dosis dan ketepatan pemilihan obat pada pasien di

Cited by 6 publications

References 19 publications

Pattern and Predictors of Medication Dosing Errors in Chronic Kidney Disease Patients in Pakistan: A Single Center Retrospective Analysis

Pattern and Predictors of Medication Dosing Errors in Chronic Kidney Disease Patients in Pakistan: A Single Center Retrospective Analysis

Appropriateness of drug dose and frequency in patients with renal dysfunction in a tertiary care hospital: A cross-sectional study

Assessment of medication Dosage Adjustment in Hospitalized Patients with Chronic Kidney Disease

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