Dosage adjustment in medical patients with renal impairment at Groote Schuur Hospital

Dose adjustment guidelines for medications in patients with renal impairment: how consistent are drug information sources?

“…It is well understood that contraindications and cautions are seldom absolute, but the differing recommendations create ambiguity and uncertainty, and canmisdirect the users or prescribers. For particular drugs, such as oral hypoglycaemics, H 2 receptor blockers, metoclopramide and many cardiovascular drugs, the information sources often did not provide explicit information for dosage adjustment, yet studies have shown that incorrect dosage adjustments are common with these categories of drugs . Guidelines for dose adjustment in renal impairment, even for drugs with a narrow therapeutic index (e.g.…”

“…For particular drugs, such as oral hypoglycaemics, H2 receptor blockers, metoclopramide and many cardiovascular drugs, the information sources often did not provide explicit information for dosage adjustment, yet studies have shown that incorrect dosage adjustments are common with these categories of drugs. 17,36 Guidelines for dose adjustment in renal impairment, even for drugs with a narrow therapeutic index (e.g. digoxin and lithium), were poorly mentioned in the information sources.…”

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.…”

Editors choice

“…3 They found renal impairment in 32% of medical admissions. Dosage adjustment was required in 19% of prescription entries, and only 32% of these were correctly adjusted.…”