Adherence with Dosing Guideline in Patients with Impaired Renal Function at Hospital Discharge

Abstract

ObjectivesTo determine the prevalence, determinants, and potential clinical relevance of adherence with the Dutch dosing guideline in patients with impaired renal function at hospital discharge.DesignRetrospective cohort study between January 2007 and July 2011.SettingAcademic teaching hospital in the Netherlands.SubjectsPatients with an estimated glomerular filtration rate (eGFR) between 10-50 ml/min/1.73m2 at discharge and prescribed one or more medicines of which the dose is renal function dependent.Main Outcome MeasuresThe prevalence of adherence with the Dutch renal dosing guideline was investigated, and the influence of possible determinants, such as reporting the eGFR and severity of renal impairment (severe: eGFR<30 and moderate: eGFR 30-50 ml/min/1.73m2). Furthermore, the potential clinical relevance of non-adherence was assessed.Results1327 patients were included, mean age 67 years, mean eGFR 38 ml/min/1.73m2. Adherence with the guideline was present in 53.9% (n=715) of patients. Reporting the eGFR, which was incorporated since April 2009, resulted in more adherence with the guideline: 50.7% vs. 57.0%, RR 1.12 (95% CI 1.02-1.25). Adherence was less in patients with severe renal impairment (46.0%), compared to patients with moderate renal impairment (58.1%, RR 0.79; 95% CI 0.70-0.89). 71.4% of the cases of non-adherence had the potential to cause moderate to severe harm.ConclusionRequired dosage adjustments in case of impaired renal function are often not performed at hospital discharge, which may cause harm to the majority of patients. Reporting the eGFR can be a small and simple first step to improve adherence with dosing guidelines.

Inappropriate prescribing in chronic kidney disease: A systematic review of prevalence, associated clinical outcomes and impact of interventions

“…While almost half of the studies were cross‐sectional, 21 studies implemented interventions to reduce IP . Of these interventions, almost half were manual decision aids (n = 10), others were computerised decision support aids to physicians and pharmacists (n=9) and in the remaining studies (n=2), physicians were prompted with calculated eGFR values (Figure ).…”

“…Forty‐three of the included studies were rated as moderate or high quality (can be accessed on supporting information). All studies defined their inclusion criteria and evaluated IP objectively with comparators described clearly, where applicable .…”

“…The study population varied between 73 and 83, 850 participants. Nine of the 49 included studies had more than a thousand study participants …”

Inappropriate Medication in Non‐Hospitalized Patients With Renal Insufficiency: A Systematic Review

“…Previous research suggests that the inappropriate prescribing of drugs, either in terms of the failure to adjust drug dosage to account for renal function or the use of medications that are contraindicated in case of renal insufficiency, is common in specific settings . In hospitalized patients with impaired renal function, 15% to 74% of the drugs requiring dosage adjustments were administered at inappropriate doses or intervals . Although the majority of patients with renal insufficiency are receiving care in ambulatory settings, surprisingly little research has been conducted in this area .…”

“…15 In hospitalized patients with impaired renal function, 15% to 74% of the drugs requiring dosage adjustments were administered at inappropriate doses or intervals. 1,[16][17][18][19][20][21][22][23][24][25] Although the majority of patients with renal insufficiency are receiving care in ambulatory settings, surprisingly little research has been conducted in this area. 15 A previous systematic review by Long and colleagues, published in 2004, included six articles that addressed adherence to renal dosing guidelines in inpatient, long-term care, or ambulatory settings.…”