Drug Dose Adjustment in Dialysis Patients Admitted in Clinics Other Than Internal Medicine

Solak, Yalçın; Bıyık, Zeynep; Gaipov, Abduzhappar; Kayrak, Mehmet; Ciray, Hilal; CİZMECİOGLU, Ahmet; Tonbul, Halil Zeki; Türk, Süleyman

doi:10.1097/mjt.0b013e3182a4ef81

Cited by 6 publications

(6 citation statements)

References 10 publications

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“…Previous studies in patients with advanced CKD have shown contrasting results. Some studies have reported that in patients with advanced CKD the likelihood of PIP is less due to more vigilant monitoring and nephrology consultations, while other studies have shown an increased number of problems [24][25][26]. Further research to understand the phenomenon of PIP in general practice is needed, possibly leading to the design of interventions to optimise medication prescribing in patients with CKD.…”

Section: Discussionmentioning

confidence: 99%

Quality use of medicines in patients with chronic kidney disease

et al. 2020

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Background: Chronic kidney disease (CKD) affects drug elimination and patients with CKD require appropriate adjustment of renally cleared medications to ensure safe and effective pharmacotherapy. The main objective of this study was to determine the extent of potentially inappropriate prescribing (PIP; defined as the use of a contraindicated medication or inappropriately high dose according to the kidney function) of renally-cleared medications commonly prescribed in Australian primary care, based on two measures of kidney function. A secondary aim was to assess agreement between the two measures. Methods: Retrospective analysis of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016; collected from 329 general practices). All adults (aged ≥18 years) with CKD presenting to general practices across Australia were included in the analysis. Patients were considered to have CKD if they had two or more estimated glomerular filtration rate (eGFR) recorded values < 60 mL/min/1.73m 2 , and/or two urinary albumin/creatinine ratios ≥3.5 mg/mmol in females (≥2.5 mg/mmol in males) at least 90 days apart. PIP was assessed for 49 commonly prescribed medications using the Cockcroft-Gault (CG) equation/eGFR as per the instructions in the Australian Medicines Handbook. Results: A total of 48,731 patients met the Kidney Health Australia (KHA) definition for CKD and had prescriptions recorded within 90 days of measuring serum creatinine (SCr)/estimated glomerular filtration rate (eGFR). Overall, 28, 729 patients were prescribed one or more of the 49 medications of interest. Approximately 35% (n = 9926) of these patients had at least one PIP based on either the Cockcroft-Gault (CG) equation or eGFR (CKD-EPI; CKD-Epidemiology Collaboration Equation). There was good agreement between CG and eGFR while determining the appropriateness of medications, with approximately 97% of the medications classified as appropriate by eGFR also being considered appropriate by the CG equation. Conclusion: This study highlights that PIP commonly occurs in primary care patients with CKD and the need for further research to understand why and how this can be minimised. The findings also show that the eGFR provides clinicians a potential alternative to the CG formula when estimating kidney function to guide drug appropriateness and dosing.

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Section: Discussionmentioning

confidence: 99%

Quality use of medicines in patients with chronic kidney disease

et al. 2020

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“…The rate of inappropriate prescriptions obtained in our study is considered to be high. Several reasons may contribute to inappropriate drug dosing in renal failure 16,19,21. These include not reviewing renal function tests before prescribing, which was reflected by the high number of exclusions due to missing serum creatinine level in our patients’ charts.…”

Section: Discussionmentioning

confidence: 99%

“…Other finding in our study reported that dialysis patients had lower rates of inadequate adjustment. It seems that physicians were more careful in medication prescription, made appropriate dose adjustments, and more nephrologist consultations among dialysis patients were noted 21…”

Section: Discussionmentioning

confidence: 99%

Evaluation of renal drug dosing adjustment in chronic kidney disease patients at two university hospitals in Lebanon

Saad

Hallit

Chahine

2019

Pharm Pract (Granada)

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Background: Inappropriate medication dosing in patients with chronic kidney disease can cause toxicity or ineffective therapy. Patients are at a high risk of developing related adverse events caused by the altered effect of drugs in conjunction with the use of polypharmacy to treat comorbid conditions. This necessitates adequate renal dosing adjustments. Objective: The current study aims at assessing whether appropriate dosing adjustments were made in hospitalized patients with chronic kidney disease. Methods: A retrospective descriptive study was conducted at two university hospitals in Beirut between January and December 2016. All adult CKD patients with creatinine clearance less than 60 ml/min and receiving at least one medication that require renal dosing adjustment were included. Kidney function was estimated from serum creatinine using Cockcroft-Gault equation, and dose appropriateness was determined by comparing practice with specific guidelines. The rates of renal drug dosing adjustment were investigated, in addition to the influence of possible determinants, such as the severity of renal impairment, reason of hospital admission, and other patient characteristics. Results: 2138 patients admitted in 2016 were screened. 223 adults receiving 578 drug orders that require adjustment were included. Among the 578 orders, 215 (37%) were adjusted adequately, 284 (49%) were adjusted inadequately, and 79 (14%) were not adjusted at all. Beta-blockers were the most inadequately dosed (83.6%) class of medication, whereas lipid-lowering agents had the highest percentage of adequate dosing (65.1%). As per patient, 84.3% of patients appeared to be receiving at least one inappropriate drug dose. Conclusions: Our study confirms that physicians are not prescribing appropriate dosing adjustments in chronic kidney disease inpatients, which may have deleterious effects. This highlights the need for more nephrology consultation and the implementation of physician education programs.

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“…Some studies have reported that in patients with advanced CKD the likelihood of PIP is less due to more vigilant monitoring and nephrology consultations, while other studies have shown an increased number of problems. [23][24][25] Further research to understand the phenomenon of PIP in general practice is needed, possibly leading to the design of interventions to optimise medication prescribing in patients with CKD. Optimal use of current eHR systems to flag renally-impaired patients so that PIP is identified is likely to be part of an intervention.…”

Section: Discussionmentioning

confidence: 99%

Quality Use of Medicines in Patients With Chronic Kidney Disease

Castelino

Saunder

Kitsos

et al. 2020

Preprint

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Objective: To determine the extent of potentially inappropriate prescribing (PIP; defined as the use of a contraindicated medication or inappropriately high dose according to the kidney function) of renally-cleared medications commonly prescribed in Australian primary care, based on two measures of kidney function. A secondary aim was to assess agreement between the two measures.Design: Retrospective analysis of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016; collected from 329 general practices). Setting & Participants: All adults (aged ≥18 years) with chronic kidney disease (CKD) presenting to general practices across Australia.Results: A total of 48,731 patients met the Kidney Health Australia (KHA) definition for CKD and had prescriptions recorded within 90 days of measuring serum creatinine (SCr)/estimated glomerular filtration rate (eGFR). Overall, 28,729 patients were prescribed one or more of the 49 medications of interest. Approximately 35% (n=9,926) of these patients had at least one PIP based on either the Cockcroft-Gault (CG) equation or eGFR (CKD-EPI; CKD-Epidemiology Collaboration Equation). There was good agreement between CG and eGFR while determining the appropriateness of medications, with approximately 97% of the medications classified as appropriate by eGFR also being considered appropriate by the CG equation.Conclusion: This study highlights that PIP commonly occurs in primary care patients with CKD and the need for further research to understand why and how this can be minimised. The findings also show that the eGFR provides clinicians a potential alternative to the CG formula when estimating kidney function to guide drug appropriateness and dosing.

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Drug Dose Adjustment in Dialysis Patients Admitted in Clinics Other Than Internal Medicine

Cited by 6 publications

References 10 publications

Quality use of medicines in patients with chronic kidney disease

Quality use of medicines in patients with chronic kidney disease

Evaluation of renal drug dosing adjustment in chronic kidney disease patients at two university hospitals in Lebanon

Quality Use of Medicines in Patients With Chronic Kidney Disease

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