Pharmacotherapy assessment in chronic kidney disease: validation of the PAIR instrument for use in Brazil

Abstract

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.

Influencing factors and their relationships of risk perception and decision-making behaviour of polypharmacy in patients with chronic diseases: a qualitative descriptive study

“…However, it has been confirmed by research that polypharmacy was combined with renal impairment and exposed patients to the risk of drug-related problems. 42 The concurrent use of multiple medications increased the risk of kidney dysfunction among older adults because it could burden the ageing kidneys to excrete multiple pharmaceutical ingredients and their metabolites. 43 The results of other relevant studies on the impact of polypharmacy on kidney function also indicated that every additional drug prescribed among older adults will have an independent and immediate harmful impact on their kidney function.…”

O Tripé Do Emagrecimento: Inteligência Emocional, Prática Esportiva E Nutrição Alimentar

“…O grupo de pacientes mais propícios para o surgimento desta situação são os idosos, onde apresentam riscos mais elevados de serem vítimas de interações medicamentosas, em função de alterações fisiológicas importantes, que ocorrem com o envelhecimento, principalmente nas funções hepática, renal e cardíaca, além da diminuição da massa muscular, do nível de albumina sérica e da quantidade total de água no organismo (MARQUITO et al, 2020).…”

“…A idade por si só não representa um fator de risco, mas um indicador para comorbidade, pois neste grupo a farmacocinética alterada e o advento da polifarmácia são as variáveis mais diretamente associadas às RAM. Idade avançada, sexo feminino, número elevado de fármacos, maiores doses e tratamentos prolongados, reações adversas prévias, enfermidades subjacentes, valoração clínica inadequada, mau cumprimento terapêutico (apego terapêutico), automedicação, estado nutricional alterado, alterações em farmacocinética e, farmacodinâmica são grandes fatores predisponentes para o surgimento das reações adversa a medicamentos um terço deste episódio são dependentes das doses (MARQUITO et al, 2020).…”

“…Apesar da existência de alternativas farmacológicas tão ou mais eficazes, é definida como prescrição inadequada de medicamentos. A polifarmácia aumentou de modo importante (CONFORTIN, et al 2015), é categórico ao afirmar que, nos últimos anos, apesar de não ser uma questão contemporânea (MARQUITO et al, 2020).…”

Response to the article “Pharmacotherapy assessment in chronic kidney disease: validation of the pair instrument for use in Brazil”

“…The article “ Pharmacotherapy assessment in chronic kidney disease: validation of the pair instrument for use in Brazil ” 1 , authored by Alessandra Batista Marquito, Hélady Sanders Pinheiro, Natália Maria da Silva Fernandes, and Rogério Baumgratz de Paula, aimed to validate the PAIR (Pharmacotherapy Assessment in Chronic Renal Disease) instrument for use in Brazilian Portuguese. Jean-François Desrochers and collaborators, from the University of Montreal, Canada 2 , originally developed this instrument.…”