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Awareness and Knowledge Among Internal Medicine House-Staff for Dose Adjustment of Cardiovascular Drugs in Chronic Kidney Disease

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Abstract

Introduction

Patients with chronic kidney disease (CKD) are vulnerable to adverse-drug events from cardiovascular drugs.

Aim

To evaluate awareness and knowledge for appropriate dose adjustment of cardiovascular drugs in CKD patients among Internal Medicine house-staff (IMHS).

Methods

Cross-sectional convenience sample survey in Fall 2015 among 341 IMHS from multiple academic institutions in the suburban New York City metropolitan area. Awareness was whether drug dose adjustment was needed. Knowledge was correct GFR level for drug dose adjustment. Multivariate logistic regression was conducted.

Results

We found overall high percentages and high odds for all cardiovascular drugs for incorrect awareness and knowledge. Postgraduate year (PGY)-1 had greater odds than PGY-3 for Carvedilol (OR: 5.56, 95% CI: 2.19–14.12, p < 0.001) and Digoxin (OR: 3.87, 95% CI: 1.37–10.95, p < 0.05), and lesser odds than PGY3 for Atenolol (OR: 0.31, 95% CI: 0.10–0.91, p < 0.05). Nephrology exposure during medical school rotation, renal clinic, or family history had lesser odds for Carvedilol (OR: 0.45, 95% CI: 0.21–0.97, p < 0.05), Simvastatin (OR: 0.40, 95% CI: 0.16–0.97, p < 0.05), and Hydralazine (OR: 0.31, 95% CI: 0.12–0.81, p < 0.05). Nephrology exposure during residency (OR: 1.96, 95% CI: 1.10–3.50, p < 0.05) and US osteopathic graduates (OR: 2.40, 95% CI: 1.04–5.50, p < 0.05) each had greater odds for Enalapril (OR: 2.40, 95% CI: 1.04–5.50, p < 0.05). International medical graduates had lesser odds than US graduates for Amlodipine (OR: 0.30, 95% CI: 0.11–0.82, p < 0.05).

Conclusions

IMHS had overall poor awareness and knowledge for dose adjustment for common cardiovascular drugs in patients with CKD. As the majority of CKD patients are managed by their primary care providers, training programs should ensure that IMHS have adequate education in Nephrology during their residency training.

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Authors and Affiliations

  1. Department of Cardiology, Nassau University Medical Center, East Meadow, NY, USA

    Kyla D’Angelo & Daniel Chikvashvili

  2. Division of Nephrology and Hypertension, Department of Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, Box 49, East Meadow, NY, 11554, USA

    Svetlana Paul, Fnu Ranjeeta & Sofia Rubinstein

  3. Department of Business Management, Brooklyn College, Brooklyn, NY, USA

    Joshua Fogel

Authors
  1. Kyla D’Angelo
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  2. Svetlana Paul
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  3. Fnu Ranjeeta
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  4. Joshua Fogel
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  5. Daniel Chikvashvili
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  6. Sofia Rubinstein
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Corresponding author

Correspondence to Sofia Rubinstein.

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Funding

None for all authors.

Conflicts of interest/Competing interests

None declared for all authors.

Ethics approval

Study approved by local IRB.

Consent to participate

All subjects in the study gave informed consent.

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All authors approve the manuscript for publication.

Availability of data and material

Not applicable. Not able to share the data at present as we still in the process of doing sub-group analyses.

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Not applicable.

Author’s contributions

KD interpreted the data and drafted the manuscript for important intellectual content. SP gathered the data and drafted the manuscript for important intellectual content. FR interpreted the data and drafted the manuscript for important intellectual content. JF designed the study, analyzed the data, interpreted the data, and critically reviewed and revised the manuscript for important intellectual content. DC designed the study, interpreted the data, and critically reviewed and revised the manuscript for important intellectual content. SR conceptualized and designed the study, gathered the data, interpreted the data, and critically reviewed and revised the manuscript for important intellectual content.

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D’Angelo, K., Paul, S., Ranjeeta, F. et al. Awareness and Knowledge Among Internal Medicine House-Staff for Dose Adjustment of Cardiovascular Drugs in Chronic Kidney Disease. High Blood Press Cardiovasc Prev 28, 177–184 (2021). https://doi.org/10.1007/s40292-021-00438-w

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  • DOI: https://doi.org/10.1007/s40292-021-00438-w

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