Ensuring safe drug administration to pediatric patients with renal dysfunction: a multicenter study
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In pediatric patients, due to variations in baseline serum creatinine (Cr) reference values, renal dysfunctions sometimes go unnoticed. In addition, renally excreted drugs need dose adjustment while nephrotoxic drugs should be avoided altogether in patients with impaired renal function. However, most physicians are apparently unaware of these facts and may administer these drugs to vulnerable patients.
We administered a questionnaire to all physicians and pharmacists specializing in pediatric medical care at six Tokyo metropolitan government-run hospitals in Japan.
276 (59%) of 470 physicians and pharmacists participated. The rate of correct answers given by physicians who were asked to state the serum Cr reference range for 4-year-olds and 8-year-olds was 83 and 74%, respectively. On the other hand, the rate of correct answers given by pharmacists to the same question was only 27 and 24%, respectively. Only about 50% of physicians were aware that histamine H2-receptor antagonists and oseltamivir are renally excreted or that acyclovir and angiotensin II receptor blocker are nephrotoxic. However, most of the pharmacists recognized that histamine H2-receptor antagonists and oseltamivir are renally excreted drugs.
For the majority of the investigated drugs, the awareness that we need to reduce dosages for patients with renal dysfunction was insufficient. To ensure safe drug administration, communication between physicians and pharmacists is paramount. There is an urgent need for the creation of a safe drug administration protocol for pediatric patients with renal dysfunction.
KeywordsRenally excreted drugs Nephrotoxic drugs Renal dysfunction Children Chronic kidney disease (CKD) Acute kidney injury (AKI)
We wish to express our deep gratitude to Mr. Seiji Uchikawa of the Tokyo Metropolitan Children’s Medical Center Department of Pharmacology as well as Ms. Masako Tomotsune of the Medical Center’s Clinical Research Support Center for providing advice and guidance from the planning stages of this study. We also wish to thank Tokyo Pediatric Clinical Research Network for the support. The authors wish to thank Mr. James R. Valera, an employee of Tokyo Metropolitan Children’s Medical Center, for providing editorial support in the preparation of this manuscript.
This survey was performed using research funds provided by the 2013 Tokyo Metropolitan Hospitals’ Clinical Research Fund (Special Research) and the Health and Labour Sciences Research Grants (Clinical Trial on Development of New Drugs and Medical Devices).
Compliance with ethical standards
Conflict of interest
Kazumoto Iijima has received grants from Daiichi Sankyo Co. Ltd.
All of the researchers in this study complied with the Helsinki Declaration and the Ethical Guidelines for Epidemiological Studies issued by the Ministry of Health, Labour and Welfare of Japan. With regard to informed consent, explanatory documents were attached to each questionnaire, and the act of mailing back the questionnaires was regarded as an indication of the subjects’ willingness to participate in the survey. We fully protected any personal information by not collecting the subjects’ name, initials, or age. The data obtained were anonymized. Prior to implementation, the study received approval (H25-34) from the ethics committee of Tokyo Metropolitan Children’s Medical Center, this study’s sponsoring institution.
With regard to informed consent, explanatory documents were attached to each questionnaire, and the act of mailing back the questionnaires was regarded as an indication of the subjects’ willingness to participate in the survey.
- 9.Uemura O, Honda M, Matsuyama T, Ishikura K, Hataya H, Yata N, Nagai T, Ikezumi Y, Fujita N, Ito S, Iijima K, Kitagawa T. Age, gender, and body length effects on reference serum creatinine levels determined by an enzymatic method in Japanese children: a multicenter study. Clin Exp Nephrol. 2011;15:694–9.CrossRefPubMedGoogle Scholar
- 10.Ishikura K, Uemura O, Ito S, Wada N, Hattori M, Ohashi Y, Hamasaki Y, Tanaka R, Nakanishi K, Kaneko T, Honda M, Pediatric CKD. Study Group, Japan Committee of Measures for Pediatric CKD of the Japanese Society of Pediatric Nephrology. Pre-dialysis chronic kidney disease in children: results of a nationwide survey in Japan. Nephrol Dial Transpl. 2013;28:2345–55.CrossRefGoogle Scholar
- 24.National Kidney Foundation. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int suppl 3. http://www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO_2012_CKD_GL.pdf.
- 27.Goldstein SL, Kirkendall E, Nguyen H, Schaffzin JK, Bucuvalas J, Bracke T, Seid M, Ashby M, Foertmeyer N, Brunner L, Lesko A, Barclay C, Lannon C, Muething S. Electronic health record identification of nephrotoxin exposure and associated acute kidney injury. Pediatrics. 2013;132:e756–67.CrossRefPubMedGoogle Scholar
- 35.Surana S, Kumar N, Vasudeva A, Shaikh G, Jhaveri KD, Shah H, Malieckal D, Fogel J, Sidhu G, Rubinstein S. Awareness and knowledge among internal medicine house-staff for dose adjustment of commonly used medications in patients with CKD. BMC Nephrol. 2017;18:26.CrossRefPubMedPubMedCentralGoogle Scholar
- 37.Nuckols TK, Smith-Spangler C, Morton SC, Asch SM, Patel VM, Anderson LJ, Deichsel EL, Shekelle PG. The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis. Syst Rev. 2014;3:56.CrossRefPubMedPubMedCentralGoogle Scholar