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

Saad, Rayane; Hallit, Souheil; Chahine, Bahia

doi:10.18549/pharmpract.2019.1.1304

Cited by 33 publications

(57 citation statements)

References 22 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 study also revealed that 16.11% of beta-blockers contain underdose,14.09% of short duration, 32.89% of overdose, 39.60% of long duration, 35.57% of incorrect frequency, and 53.02% of incorrect route of administration, but this result was higher when compared with the research done on the USA due to the lack of updated information in [34]. Similar findings were reported in Lebanon in which beta-blockers were the most commonly prescribed class of medication requiring dosage adjustment [35]. The problem of under dose and short duration leads to the reduction of the effectiveness of treatment which leads to treatment failure and different complications.…”

Section: Discussionmentioning

confidence: 64%

Drug Use Evaluation of Beta-Blockers in Medical Wards of Nedjo General Hospital, Western Ethiopia

Fekadu

Bekele

Bekele³

et al. 2020

Cardiovascular Therapeutics

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Introduction. Beta-blocker use evaluation is a performance method that focuses on the evaluation of beta-blocker use processes to achieve optimal patient outcomes. Several studies conducted in different hospitals revealed a high incidence of inappropriate prescription of beta-blockers among hospitalized patients. Therefore, it is important to identify inappropriate beta-blocker prescribing since they may increase the risk of hospitalizations. Despite this, there was no study conducted related to drug use evaluation of beta-blockers in Nedjo general hospital (NGH). Thus, this study was aimed at assessing the use evaluation of beta-blockers in medical wards of NGH. Methods. A retrospective cross-sectional study was conducted at medical wards of NGH from January 1, 2016, to December 31, 2017. Results. Out of the total of 149 medical record of patients that contains beta-blockers, 84 (56.37%) were males and about one-third (31.54%) of the patients ages were between 41 and 50 years. Propranolol was the most commonly prescribed beta-blocker (62.76%), and 94.56% of beta-blockers were prescribed with correct indication. There were about 51%, 46.31%, 64.43%, and 46.98% of beta-blockers prescribed with the correct dose, duration, frequency, and route of administration, respectively. Regarding the routes of administration, 70 (46.98%) of them were prescribed with the correct route. Most drugs interacting were propranolol with cimetidine 26 (68.42%), and the most frequent condition for which beta-blockers were prescribed was hypertension (32.89%). Conclusion. Overall, there was an inappropriate use of beta-blockers in terms of dosage and durations. So, prescribers of NGH should strictly adhere to the national treatment guideline when prescribing medications. Additionally, drug information centers have proved useful and effective in promoting rational drug use. Hence, it should be recommended for general use.

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

Cited by 33 publications

References 22 publications

Quality use of medicines in patients with chronic kidney disease

Quality use of medicines in patients with chronic kidney disease

Drug Use Evaluation of Beta-Blockers in Medical Wards of Nedjo General Hospital, Western Ethiopia

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

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