Dosage adjustment in renal impairment

Abstract

Background: The intervention of the pharmacist in the therapy of patients with renal failure can contribute to improve safety, reducing the potential for kidney damage. Purpose: To assess the role the pharmacist plays in the field of welfare safety of patients with renal function impairment. Materials and methods: A retrospective study from January 2011 to June 2011 in a general hospital with 630 beds. Data sources: validated medical prescriptions obtained from ATHOS PRISM program. The authors consider the values of serum creatinine greater than 1.4 ml/dl and estimate the value of each patient's glomerular filtration rate (GFR) by MDRD-4 formula. The choice of drugs that were monitored was performed based on their clinical impact and volume of prescriptions. The reference values for dose adjustment of the selected drugs were obtained from various literature sources: Mensa's Antimicrobial Guide, Sandford Guide to Antimicrobial Therapy and Technical Data Sheet. Results: The authors evaluated the prescriptions of 8367 patients, 961 (11.5%) were patients with impaired renal function. Of these, 240 (24.9%) underwent intervention for inappropriate drug dosage. The interventions were accepted in 105 cases (48.3%) and not accepted by the clinician in 36 (15%). In the rest the outcome of the intervention could not be assessed: in 22.1% because the patient was discharged and in 18.8% because the drug on which the recommendation was made was suspended. The services that accepted our suggestions to a larger extent (in percentage) were surgery (100%), angiology (75%) and geriatrics (63.2%). Drugs with a greater number of accepted interventions were levofloxacin (47 over 105 accepted recommendations, 44.8%), ranitidine (10 over 105, 9.5%) and amoxicillin (8 over 105, 7.6%). Conclusions It is important to identify and review the treatment of patients with impaired renal function for an appropriate dose adjustment. The drugs that more often have been adjusted are antibiotics, of which the most remarkable for the number of interventions and adjustments has been levofloxacin