Drug-Related Problems in Hemodialysis Patients

Abstract

Polypharmacy is common in hemodialysis patients. The objective of this study is to identify drug‐related problems (DRPs) in hemodialysis patients, intervene, and resolve them. All patients undergoing dialysis at a hemodialysis center were enrolled into the study. Patients who had been hospitalized during the study period were excluded. DRPs were identified after thorough review of the patients’ medication and clinical records. DRPs were classified into 8 categories and any DRP that did not fit into the 8 categories was classified under ‘Others.’ Appropriate recommendations for the resolution of the DRPs were presented to the nephrologist in‐charge of the center and action taken. Accepted recommendations were deemed as interventions and assigned a significance rank on a scale of 1 (adverse significance) to 6 (extreme significance). Where recommendations were accepted, monitoring was carried out 2 weeks later to assess the clinical outcome of the intervention. A total of 35 patients were studied. 31 patients completed the study, 4 were lost to follow‐up. In a 3‐month period, 83 DRPs were identified and 73 interventions (88%) made. A mean of 2.7 ± 1.1 DRPs were detected per patient. Drug underdose constituted the most common DRP accounting for 35% of all DRPs. 62% of the accepted recommendations were classified as significant and given a rank of 4/6. On follow‐up, 54% of the interventions showed improved clinical outcomes. DRPs are prevalent in hemodialysis patients. The introduction of clinical pharmacy services can potentially contribute to many aspects of healthcare in hemodialysis patients through the detection and resolution of DRPs. Where clinical pharmacy services are not available, clinicians should be vigilant regarding polypharamcy and the occurrence of DRPs.

Medication Review with Follow-Up for End-Stage Renal Disease: Drug-Related Problems and Negative Outcomes Associated with Medication—A Systematic Review

“…Nine additional studies were identified from other sources (manual search and contribution by experts) [29,34,[42][43][44][45][46][47][48].…”

“…After the elimination of duplicates, application of the inclusion and exclusion criteria, consultation of the bibliographies of the selected articles, and consultation with experts (Figure 1), 16 documents with full text available were selected and retrieved [20,29,34,[42][43][44][45][46][47][48][49][50][51][52][53][54]. One of them was a doctoral thesis [34] and was related to another selected study [29].…”

“…Of the papers reviewed, 12 were observational studies [42][43][44][45][46][47][48][49][51][52][53][54] (10 cross-sectional and 2 cohort [45,53]). In addition, two were clinical trials [20,50] (one of which was controlled randomly selected [20]) and two had a quasi-experimental design [29,34].…”

“…The studies were carried out in various health care settings: hospitals [29,34,42,44,45,52], HD units [20,[46][47][48][49]51,53,54] and KT units [43,50].…”

A Preliminary Review of the Medication Management Service Conducted by Pharmacists in Haemodialysis Patients of Singapore General Hospital

“…Patients with end-stage renal disease (ESRD) are at risk of developing drug-related problems (DRPs) due to polypharmacy, multiple co-morbidities and frequent medication changes 1 . Pharmacists are in a unique position in a multidisciplinary healthcare team to identify and solve DRPs by conducting medication reconciliation and educating patients 2 .…”