Drug associations in individuals with CKD were related to high prevalence of serious DIs, especially in the later stages of the disease.

Individuals with chronic kidney disease (CKD) use polypharmacy, which, in combination with renal impairment, exposes them to the risk of drug-related problems (DRPs). There are no available tools in Brazil to systematically assess the pharmacotherapy and management of DRPs in this population. Therefore, the objective of this work was to validate the PAIR instrument (Pharmacotherapy Assessment in Chronic Renal Disease) for use in Brazilian Portuguese. This is a retrospective longitudinal observational study. Medical records from 100 CKD patients under conservative treatment, between 2016 and 2017, in a nephrology clinic, were analyzed. PAIR was applied by pharmacists in two consultations of the same patient, with an interval of 6 months. Reliability, conceptual validity, responsiveness of the instrument and prevalence of DRPs in the studied sample were assessed. A mean of 1.26 ± 0.96 DRPs/patient was identified. Inter-rater reliability coefficients (k) ranged from 0.58 to 0.94 and from 0.79 to 1.00 for test-retest, revealing moderate to perfect level of agreement. In conceptual validity, a mean of 1.60 ± 1.24 DRPs/patient was identified by the nephrologist through clinical judgment, compared to 1.33±0.76 DRPs/patient identified by the pharmacist using PAIR (p = 0.07). Therefore PAIR allowed the identification of clinically significant DRPs. In responsiveness, a mean of 1.26 ± 0.96 DRPs/patient was identified at the first consultation and 1.11 ± 1.02 DRPs/patient at the subsequent consultation (p = 0.17) by the pharmacist using PAIR. The number of DRPs between the periods did not change. As a conclusion, the PAIR allowed the identification of clinically significant DRPs in CKD, constituting a new validated instrument to be used in Brazil.

Resumo Indivíduos com doença renal crônica (DRC) frequentemente utilizam polifarmácia o que os expõe ao risco de problemas relacionados a medicamentos (PRMs). No Brasil, não existem instrumentos que possam sistematizar a avaliação da farmacoterapia e a gestão de PRMs nesta população. Portanto, o objetivo deste trabalho foi realizar a adaptação transcultural do instrumento PAIR (Pharmacotherapy Assessment in Chronic Renal Disease) para o português brasileiro. O PAIR consiste numa lista de 50 PRMs considerados clinicamente significativos para renais crônicos. O processo de adaptação transcultural envolveu as etapas de tradução, síntese, retrotradução, análise por um comitê de especialistas e pré-teste da versão preliminar. O comitê de 2 farmacêuticos e 2 nefrologistas analisou a equivalência semântica, idiomática, experiencial e conceitual entre as versões original e traduzida. Todos os itens que obtiveram acordo inferior a 80% foram revisados. Foram realizados ajustes de palavras, assim como a exclusão de 6 PRMs devido à não aplicabilidade ao contexto brasileiro. Assim, foi obtida a versão final do PAIR definida como “Avaliação da farmacoterapia na doença renal crônica”, traduzida e adaptada na língua portuguesa do Brasil.

Response to the article "Pharmacotherapy assessment in chronic kidney disease: validation of the pair instrument for use in Brazil" Carta-resposta ao artigo "Avaliação da farmacoterapia na doença renal crônica: validação do instrumento PAIR para uso no Brasil"