Impact of a Renal Drug Dosing Service on Dose Adjustment in Hospitalized Patients with Chronic Kidney Disease

Hassan, Yahaya; Al-Ramahi, Rowa′; Aziz, Noorizan Abd; Ghazali, Rozina

doi:10.1345/aph.1m187

Cited by 94 publications

(118 citation statements)

References 39 publications

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“…Amikacin, Amoxicllin/ Clavulanate, Imipenem/Cilastatin, Piperacillin/Tazobactum, Valacyclovir, Trimethoprim/Sulfamethoxazole, Cefoperazone/Sulbactum, Bisoprolol, Digoxin were not dosed as per the recommendations. In our study, the inappropriateness rate of antibiotics was 27%, which is similar to the study by Hassan Y et al 5 In the same study the rate of inappropriateness in prescribing the cardiovascular medications was 61%, compared to 32% in our study, a majority being Anti-arrhythmics. The type of dosage adjustments needed were found to be dose reduction in 37% of the drugs, change of dosing interval in 46% of the drugs, and about 17% of the drugs were contraindicated for the prescribing in renal function ( Table 3).…”

Section: Pre Interventional Phasesupporting

confidence: 90%

“…The extent of inappropriate dosing is low in our study compared to the published literature. 5,6 This may be due to the increased awareness of the clinicians regarding the renal dosing in our setting. Among the 59 drugs that were dosed inappropriately, majority of drugs were antibiotics.…”

Section: Pre Interventional Phasementioning

confidence: 99%

“…Healthcare professionals should be familiar with commonly used medications that require dosage adjustments. 3,4 Dosages of drugs cleared renally are based on renal function calculated as Glomerular Filtration Rate (GFR) or Creatinine Clearance (CrCl). Examples of drugs requiring dose adjustment in patients with renal impairment mostly include antibiotics, digoxin, Histamine-2-receptor antagonists, and Angiotensin converting enzyme inhibitors.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Development of Renal Dosing Guidelines: A Prospective Study

Parvathagiri¹,

Yerramilli²,

Mudigonda³

et al. 2016

IJOPP

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Background: Patients with Chronic Kidney Disease are at increased risk for potentially harmful prescribing. The selection of appropriate dosing for patients with Chronic Kidney Disease is important to avoid unwanted drug effects, maximize therapeutic efficacy and ensure optimal patient outcomes. Aim: To study the impact of renal dosing guidelines on prescribing pattern in patients with CKD. Methods: This was a prospective, interventional study conducted at a tertiary care centre. In the pre-interventional phase, the case sheets of all the in-patients with CKD with creatinine clearance of <50mL/min were collected and reviewed for the demographics, lab parameters and medications prescribed. The pre-intervention phase served as the control.As a part of intervention, pocket guides were prepared listing out the drug dosing in renal impairment and were distributed to all clinicians and the patient care areas. In the post-interventional phase, the drug charts were reviewed to observe any improvement in the dosing pattern of renally eliminated drugs. Results: In the pre-intervention study, drug dosing adjustment was needed in 246 drugs where 59 drugs (23%) were inappropriately dosed. In the post-intervention study, this number was significantly lowered to 23 (8%) drugs out of 284 drugs (p=0.0001) which needed renal dosing. Statistically significant improvements were seen with prescribing of antibiotics (p=0.0017), hypolipidemics (p=0.0449) and antiarrhythmic agents (p=0.0034). Conclusion: The dosing of majority of the renally eliminated drugs followed the recommendations of the package inserts. With the increasing awareness created by the pocket guides, there was a significant improvement in renal dosing. There is a need in health care settings to monitor the use of renally eliminated medications to reduce the adverse effects. The clinical pharmacists in collaboration with clinicians play a significant role in optimizing patient outcomes.

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Section: Pre Interventional Phasesupporting

confidence: 90%

Section: Pre Interventional Phasementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Development of Renal Dosing Guidelines: A Prospective Study

Parvathagiri¹,

Yerramilli²,

Mudigonda³

et al. 2016

IJOPP

View full text Add to dashboard Cite

show abstract

“…Interventions were in following areas antimicrobial management [17][18][19][20][21][22], targeted drug programmes [23][24][25][26], multidimensional clinical pharmacy service [27][28][29], paediatric programmes [30,31], renal specialist [32,33], pharmacotherapeutic optimisation [34,35], intensive care service [36,37] and neurosurgery [38]. All intervention types have been identified in previous reviews of the literature [10][11][12][13].…”

Section: Clinical Pharmacy Interventionsmentioning

confidence: 99%

Economic evaluations of clinical pharmacist interventions on hospital inpatients: a systematic review of recent literature

2014

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“…35 Active pharmacist involvement in ensuring proper doses of renally eliminated medications has been demonstrated to decrease adverse effects and result in cost savings. 131 Such dosage adjustments are especially important in patients with advanced nephropathy requiring dialysis. Pharmacists should be familiar with various dialysis modalities and their effects on medication removal.…”

Section: Pharmacist Involvement In the Management Of Hiv Disease Statmentioning

confidence: 99%

ASHP Guidelines on Pharmacist Involvement in HIV Care

Schafer

Gill

Sherman

et al. 2016

American Journal of Health-System Pharmacy

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Impact of a Renal Drug Dosing Service on Dose Adjustment in Hospitalized Patients with Chronic Kidney Disease

Abstract: A renal drug dosing service for patients hospitalized with CKD can increase the proportion of drug dosing that is adjusted to take into account renal function. This can save drug costs and may prevent ADEs.

Cited by 94 publications

References 39 publications

Development of Renal Dosing Guidelines: A Prospective Study

Development of Renal Dosing Guidelines: A Prospective Study

Economic evaluations of clinical pharmacist interventions on hospital inpatients: a systematic review of recent literature

ASHP Guidelines on Pharmacist Involvement in HIV Care

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