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Use of renal risk drugs in patients with renal impairment

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Abstract

Background Renal impairment often goes unrecognised until the most advanced stages. Patients with renal impairment use a variety of drugs and the pharmacokinetics and drug effects are prone to change. Objective Describe drug related problems in a population of patients with renal impairment, investigate possible risk factors, and investigate whether the clinical pharmacist can propose relevant measures to solve the problems. Setting The internal medicine department at Innlandet Hospital Trust Gjøvik, Norway. Method A prospective study enrolling patients (≥18 years) with moderate and severe renal impairment, i.e. with glomerular filtration rate of 30–59 and 15–29 ml/min/1.73 m2, respectively, and using at least one drug. The clinical pharmacist reviewed the patients’ drug regimen with focus on drug related problems, related to renal function. Problems identified were discussed with the multidisciplinary team, or directly with the physician. Main outcome measure The number of drug related problems. Results The results are based on data from 79 patients, 21 with severe and 58 with moderate renal impairment. Most patients, 92.4 %, used 5 or more drugs; in average 10.2 (range 2–27). In total, 88 drug related problems were identified in 49 patients, i.e. in 62 %. The most frequently occurring problems were incorrect dose (45.5 %) and inappropriate drug (41.0 %). There was a significant correlation between both the degree of renal impairment and the number of drugs, and the number of drug related problems. The acceptance rate of the clinical pharmacist’s interventions was 95.7 %. The drugs most frequently associated with drug related problems were metformin, benzylpenicillin and furosemide. Conclusion Drug related problems often occur in patients with renal impairment. Incorrect drug dose and inappropriate drug choice according to the patients’ renal function were the most common problems. Patients with the most complex drug treatment, i.e. with increasing degree of renal impairment and increasing number of drugs, are at greater risk of drug related problems. The high acceptance rate for the pharmacist’s interventions supports the inclusion of a clinical pharmacist in the multidisciplinary treatment team to increase awareness and optimisation of the drug treatment in this patient group.

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References

  1. Blix HS, Viktil KK, Moger TA, Reikvam A. Use of renal risk drugs in hospitalized patients with impaired renal function—an underestimated problem? Nephrol Dial Transplant. 2006;21(11):3164–71.

    Article  PubMed  Google Scholar 

  2. Salomon L, Deray G, Jaudon MC, Chebassier C, Bossi P, Launay-Vacher V, et al. Medication misuse in hospitalized patients with renal impairment. Int J Qual Health Care. 2003;15(4):331–5.

    Article  CAS  PubMed  Google Scholar 

  3. Hug BL, Witkowski DJ, Sox CM, Keohane CA, Seger DL, Yoon C, et al. Occurrence of adverse, often preventable, events in community hospitals involving nephrotoxic drugs or those excreted by the kidney. Kidney Int. 2009;76(11):1192–8.

    Article  PubMed  Google Scholar 

  4. Cox ZL, McCoy AB, Matheny ME, Bhave G, Peterson NB, Siew ED, et al. Adverse drug events during AKI and its recovery. Clin J Am Soc Nephrol. 2013;8(7):1070–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Pillans PI, Landsberg PG, Fleming AM, Fanning M, Sturtevant JM. Evaluation of dosage adjustment in patients with renal impairment. Intern Med J. 2003;33(1–2):10–3.

    Article  CAS  PubMed  Google Scholar 

  6. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.

    Article  Google Scholar 

  7. Verbeeck RK, Musuamba FT. Pharmacokinetics and dosage adjustment in patients with renal dysfunction. Eur J Clin Pharmacol. 2009;65(8):757–73.

    Article  CAS  PubMed  Google Scholar 

  8. Gabardi S, Abramson S. Drug dosing in chronic kidney disease. Med Clin North Am. 2005;89(3):649–87.

    Article  CAS  PubMed  Google Scholar 

  9. Pannu N, Nadim MK. An overview of drug-induced acute kidney injury. Crit Care Med. 2008;36(4 Suppl):216–23.

    Article  Google Scholar 

  10. Hallan SI, Coresh J, Astor BC, Asberg A, Powe NR, Romundstad S, et al. International comparison of the relationship of chronic kidney disease prevalence and ESRD risk. J Am Soc Nephrol. 2006;17(8):2275–84.

    Article  PubMed  Google Scholar 

  11. Coresh J, Byrd-Holt D, Astor BC, Briggs JP, Eggers PW, Lacher DA, et al. Chronic kidney disease awareness, prevalence, and trends among U.S. adults, 1999 to 2000. J Am Soc Nephrol. 2005;16(1):180–8.

    Article  PubMed  Google Scholar 

  12. Viktil KK, Blix HS. The impact of clinical pharmacists on drug-related problems and clinical outcomes. Basic Clin Pharmacol Toxicol. 2008;102(3):275–80.

    Article  CAS  PubMed  Google Scholar 

  13. Stemer G, Lemmens-Gruber R. Clinical pharmacy activities in chronic kidney disease and end-stage renal disease patients: a systematic literature review. BMC Nephrol. 2011;12:35.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145(4):247–54.

    Article  CAS  PubMed  Google Scholar 

  15. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31–41.

    Article  CAS  PubMed  Google Scholar 

  16. Ruths S, Viktil KK, Blix HS. Classification of drug-related problems. Tidsskr Nor Laegefor. 2007;127(23):3073–6.

    Google Scholar 

  17. Norsk Legemiddelhåndbok for helsepersonell. Oslo: Foreningen for utgivelse av Norsk Legemiddelhåndbok; 2010.

  18. Currie A, Ashley C, editors. The renal drug handbook. Abingdon: Radcliffe Medical PR; 2008.

    Google Scholar 

  19. Prajapati A, Ganguly B. Appropriateness of drug dose and frequency in patients with renal dysfunction in a tertiary care hospital: a cross-sectional study. J Pharm Bioallied Sci. 2013;5(2):136–40.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Nasjonale faglige retningslinjer. Diabetes: forebygging, diagnostikk og behandling. Oslo: Norwegian Directorate of Health; 2009.

    Google Scholar 

  21. Wong NA, Jones HW. An analysis of discharge drug prescribing amongst elderly patients with renal impairment. Postgrad Med J. 1998;74(873):420–2.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Vidal L, Shavit M, Fraser A, Paul M, Leibovici L. Systematic comparison of four sources of drug information regarding adjustment of dose for renal function. BMJ. 2005;331(7511):263.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Khanal A, Castelino RL, Peterson GM, Jose MD. Dose adjustment guidelines for medications in patients with renal impairment: how consistent are drug information sources? Intern Med J. 2014;44(1):77–85.

    Article  CAS  PubMed  Google Scholar 

  24. Breton G, Froissart M, Janus N, Launay-Vacher V, Berr C, Tzourio C, et al. Inappropriate drug use and mortality in community-dwelling elderly with impaired kidney function—the Three-City population-based study. Nephrol Dial Transplant. 2011;26(9):2852–9.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Blix HS, Viktil KK, Moger TA, Reikvam A. Characteristics of drug-related problems discussed by hospital pharmacists in multidisciplinary teams. Pharm World Sci. 2006;28(3):152–8.

    Article  PubMed  Google Scholar 

  26. Joosten H, Drion I, Boogerd KJ, van der Pijl EV, Slingerland RJ, Slaets JP, et al. Optimising drug prescribing and dispensing in subjects at risk for drug errors due to renal impairment: improving drug safety in primary healthcare by low eGFR alerts. BMJ Open. 2013;3(1):e002068. doi:10.1136/bmjopen-2012-002068

    Article  PubMed Central  PubMed  Google Scholar 

  27. Gudmundsdottir H, Aksnes H, Heldal K, Krogh A, Froyshov S, Rudberg N, et al. Metformin and antihypertensive therapy with drugs blocking the renin angiotensin system, a cause of concern? Clin Nephrol. 2006;66(5):380–5.

    Article  CAS  PubMed  Google Scholar 

  28. Calabrese AT, Coley KC, DaPos SV, Swanson D, Rao RH. Evaluation of prescribing practices: risk of lactic acidosis with metformin therapy. Arch Intern Med. 2002;162(4):434–7.

    Article  PubMed  Google Scholar 

  29. von der Lippe E. Dosage of antibiotics in patients with reduced renal function. Tidsskr Nor Laegefor. 2002;122(25):2461–3.

    Google Scholar 

  30. Bilge U, Sahin G, Unluoglu I, Ipek M, Durdu M, Keskin A. Inappropriate use of nonsteroidal anti-inflammatory drugs and other drugs in chronic kidney disease patients without renal replacement therapy. Ren Fail. 2013;35(6):906–10.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We would like to thank all members of the health care teams in the participating department.

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Authors and Affiliations

  1. Gjøvik Hospital Pharmacy, Hospital Pharmacies Enterprise, South Eastern Norway, Kyrre Greppsgt 11, 2819, Gjøvik, Norway

    Hilde Holm

  2. Department of Global Public Health and Primary Care, Centre for Pharmacy, University of Bergen, Postboks 7804, 5020, Bergen, Norway

    Kirsti Bjerke & Lone Holst

  3. Hospital Pharmacies Enterprise, South Eastern Norway, Stenersgate 1, Postkasse 79, 0050, Oslo, Norway

    Liv Mathiesen

Authors
  1. Hilde Holm
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Correspondence to Hilde Holm.

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Holm, H., Bjerke, K., Holst, L. et al. Use of renal risk drugs in patients with renal impairment. Int J Clin Pharm 37, 1136–1142 (2015). https://doi.org/10.1007/s11096-015-0175-3

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  • DOI: https://doi.org/10.1007/s11096-015-0175-3

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