Adherence with renal dosing recommendations in outpatients undergoing haemodialysis.
J Clin Pharm Ther
; 41(1): 26-33, 2016 Feb.
Article
em En
| MEDLINE
| ID: mdl-26678854
ABSTRACT
WHAT IS KNOWN AND OBJECTIVE:
Adjustment of drug dosage in patients with end-stage renal disease prevents serious adverse effects, which occur due to the accumulation of drugs or other toxic metabolites. Nevertheless, dosing errors occur most commonly among patients with end-stage renal disease. The aim of this study was to assess the quality of care for end-stage renal disease outpatients using their renal dosing adjustment status.METHODS:
A cross-sectional study was performed using the data collected from 43 South Korean medical institutions via questionnaires. A total of 2428 patients on haemodialysis, who were at least 18 years of age, were included. Among these patients, the study population was confined to patients who were taking medications and required renal dosing adjustments from three therapeutic classes antihypertensives, antihyperglycaemics and lipid-modifying agents. The study population (n = 828) was prescribed a total of 1097 drug orders for the target drugs. Determination of appropriate dosage adjustment was based on GFR (glomerular filtration rate) using the Modification of Diet in Renal Disease revised 4-variable equation. The primary outcome was non-adherence to drug dosing requirements for end-stage renal disease patients with consideration to their renal function. RESULTS ANDDISCUSSION:
Among the study population (n = 828), 469 haemodialysis patients were identified as having drug orders that were adherent to renal dosing recommendations. There were significant differences between the patient groups who received recommendation-adherent and non-adherent drug orders in the characteristics of the medical institutions they visited, causes of chronic renal failure and prevalence of concurrent diabetes mellitus. The primary factor of non-adherence to renal dosing adjustment recommendations was characteristics of medical institutions. Compared to tertiary hospitals, secondary hospitals and primary care clinics were 1·16 and 1·22 times, respectively, more non-adherent in accordance with the multivariate analysis (OR 1.16, 95% CI 1.02-1.20, OR 1.22, 95% CI 1·00-1·36, respectively). WHAT IS NEW ANDCONCLUSIONS:
Dosing error is one of the most common problems among patients with renal failure. To decrease the dosing errors, an improvement needs to be made in medical institutions. This can be accomplished by implementing the clinical decision support systems that educate physicians on appropriate renal dosing and help them prescribe appropriate drug dosages.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Diálise Renal
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Hipoglicemiantes
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Falência Renal Crônica
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Anti-Hipertensivos
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Hipolipemiantes
Tipo de estudo:
Guideline
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Observational_studies
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Prevalence_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adolescent
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Adult
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Aged
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Female
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Humans
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Male
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Middle aged
País como assunto:
Asia
Idioma:
En
Ano de publicação:
2016
Tipo de documento:
Article