Use of renal risk drugs in patients with renal impairment

Abstract

Drug related problems often occur in patients with renal impairment. Incorrect drug dose and inappropriate drug choice according to the patients' renal function were the most common problems. Patients with the most complex drug treatment, i.e. with increasing degree of renal impairment and increasing number of drugs, are at greater risk of drug related problems. The high acceptance rate for the pharmacist's interventions supports the inclusion of a clinical pharmacist in the multidisciplinary treatment team to increase awareness and optimisation of the drug treatment in this patient group.

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 .…”

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.…”

Feasibility of Retrograde Ureteral Contrast Injection to Guide Ultrasonographic Percutaneous Renal Access in the Nondilated Collecting System

“…One potential disadvantage of this approach is that it requires intravenous injection of furosemide, which can be associated with medication side effects, including acute renal insufficiency or even hearing loss. 29,30 Retrograde ultrasound contrast injection puts the agent only in contact with the collecting system lining. Given that intravascular injection has been shown to be safe, the collecting system injection should be extremely safe since it does not involve contact with antigen-containing epithelial surfaces.…”