RESUMO
INTRODUCTION: Chronic kidney disease (CKD) is a major health problem. Early detection is the key to reducing morbidity and mortality, but it is difficult because it occurs without symptoms. Diagnosis of CKD is also important to avoid nephrotoxic drugs and to adjust the doses of other medications that may be affected. Pharmacies, due to their proximity to the population, frequency of patient visits, and knowledge of medication use are an ideal location for point-of-care diagnosis or CKD. OBJECTIVE: To detect and refer to the primary care physician patients with low estimated glomerular filtration rate (eGFR) who use nephrotoxic drugs or who may require a dose adjustment. METHODOLOGY: Pharmacy users over 60 years of age who agreed to participate were given a creatinine/eGFR test with a point-of-care meter. The eGFR was calculated and if it was less than 60 ml/min/1.73 m2, their medications were evaluated to identify nephrotoxic drugs or drugs that potentially required adjustment. If either were found, they were referred to their doctor for further management. RESULTS: 198 patients were recruited in 4 pharmacies, of which 87 (43.9%) had an eGFR less than 60 ml/min/1.73 m2. They were taking a total of 635 medications. Of these 635 medications, 50 (7.9%) were affected by kidney function. Dose adjustment was recommended in 31 and discontinuation in 19. The primary care doctor accepted the recommendations for 14 medications: dose adjustment for 6 and withdrawal in 8. This represents 2.3% of medications taken by patients with an eGFR less than 60 ml/min/1.73 m2. The 50 medications identified were taken by 29 patients (33.3% of the 87 with a low eGFR) and a change in treatment was generated in 9 patients, representing 4.6% of the total number of patients in the sample, and 10% of the patients with a low eGFR. CONCLUSION: Point-of-care testing for kidney function in a pharmacy setting is feasible and identifies a significant number of patients with eGFR under 60 ml/min/1.73 m2. It also allows for appropriate medication management recommendations in this patient group.
Assuntos
Assistência Farmacêutica , Farmácias , Insuficiência Renal Crônica , Humanos , Pessoa de Meia-Idade , Idoso , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/tratamento farmacológico , Insuficiência Renal Crônica/epidemiologia , Taxa de Filtração GlomerularRESUMO
INTRODUCCIÓN: en la farmacia comunitaria se realizan determinaciones de parámetros analíticos cada vez con más frecuencia. Los valores obtenidos son muy útiles en el trabajo de atención farmacéutica. Uno de ellos, la creatinina en sangre, puede ser especialmente útil para la detección y seguimiento de la enfermedad renal crónica. Además, permitiría sugerir al clínico la desprescripción o ajuste de dosis de determinados medicamentos nefrotóxicos o de eliminación renal en función del filtrado glomerular calculado. Se plantea valorar la utilidad de un nuevo aparato, el StatSensor Xpress Creatinine® de Nova Biomedical como paso previo a la realización de un estudio sobre la posibilidad de implantar un servicio con estas características. MATERIAL Y MÉTODOS: a partir de una muestra de sangre proporcionada por uno de los investigadores y una solución control de creatinina se preparan 35 muestras que son analizadas con el aparato problema. Otras 35 muestras alícuotas de las primeras son analizadas por un laboratorio de referencia. Se evalúan la exactitud, rendimiento diagnóstico y precisión mediante las pruebas Passing Bablock, coeficiente de correlación de Lin, Bland Altman, sensibilidad y especificidad diagnóstica y coeficiente de variación. RESULTADOS: la prueba de Passing Bablock y el coeficiente de Lin son correctos. Bland Altman es estadísticamente significativa en valores superiores a 5 mg/dl. La sensibilidad y especificidad diagnósticas son del 100 % y el coeficiente de variación es menor del 5 %. CONCLUSIÓN: el analizador de mano StatSensor Xpress Creatinine® es válido en el rango de valores habituales en farmacia comunitaria
INTRODUCTION: At community pharmacy, determinations of analytical parameters are made more and more frequently. The values obtained are particularly useful in Pharmaceutical Care work. One of them, blood creatinine, can be especially useful for the detection and monitoring of chronic renal disease. In addition, it would allow to suggest to the clinician the deprescription or dose adjustment of certain nephrotoxic or renal elimination drugs according to the calculated glomerular filtrate. The usefulness of a new device, the StatSensor Xpress Creatinine® by Nova Biomedical, is being considered as a preliminary step to carrying out a study on the possibility of implementing a professional service with these characteristics. MATERIAL AND METHODS: From a blood sample provided by one of the researchers and a creatinine control solution, 35 samples are prepared and analyzed with the test device. Another 35 aliquots of the former are analyzed by a reference laboratory. Accuracy, diagnostic performance and precision are evaluated using the Passing Bablock, Lin correlation coefficient, Bland Altman, diagnostic sensitivity and specificity, and coefficient of variation tests. RESULTS: The Passing Bablock test and the Lin coefficient are correct. Bland Altman is statistically significant at values greater than 5 mg/dL. Diagnostic sensitivity and specificity are 100% and the coefficient of variation is less than 5%. CONCLUSION: The StatSensor Xpress Creatinine® Handheld Analyzer is valid in the range of common community pharmacy values
