1. Correct use of non-indexed eGFR for drug dosing and renal drug-related problems at hospital admission.
- Author
-
Seiberth, Sarah, Bauer, Dominik, Schönermarck, Ulf, Mannell, Hanna, Stief, Christian, Hasford, Joerg, and Strobach, Dorothea
- Subjects
ACADEMIC medical centers ,CHRONIC kidney failure ,DRUG interactions ,DRUG side effects ,DRUG toxicity ,GLOMERULAR filtration rate ,HOSPITAL care ,SCIENTIFIC observation ,PHARMACEUTICAL arithmetic ,RETROSPECTIVE studies ,DESCRIPTIVE statistics ,MEDICATION reconciliation - Abstract
Purpose: Two to seven percent of the German adult population has a renal impairment (RI) with an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m
2 . This often remains unrecognized and adjustment of drug therapy is lacking. To determine renal function in clinical routine, the CKD-EPI equation is used to calculate an indexed eGFR (ml/min/1.73m2 ). For drug dosing, it has to be individualized to a non-indexed eGFR (ml/min) by the patient's body surface area. Here, we investigated the number of patients admitted to urological wards of a teaching hospital with RI between July and December 2016. Additionally, we correctly used the eGFRnon-indexed for drug and dosage adjustments and to analyse the use of renal risk drugs (RRD) and renal drug-related problems (rDRP). Methods: In a retrospective observational study, urological patients with pharmacist-led medication reconciliation at hospital admission and eGFRindexed (CKD-EPI) of 15–59 ml/min/1.73m2 were identified. Indexed eGFR (ml/min/1.73m2 ) was recalculated with body surface area to non-indexed eGFR (ml/min) for correct drug dosing. Medication at admission was reviewed for RRD and based on the eGFRnon-indexed for rDRP, e.g. inappropriate dose or contraindication. Results: Of 1320 screened patients, 270 (20.5%) presented with an eGFRindexed of 15–59 ml/min/1.73m2 . After readjustment, 203 (15.4%) patients had an eGFRnon-indexed of 15–59 ml/min. Of these, 190 (93.6%) used ≥ 1 drugs at admission with 660 of 1209 (54.7%) drugs classified as RRD. At least one rDRP was identified in 115 (60.5%) patients concerning 264 (21.8%) drugs. Conclusion: Renal impairment is a common risk factor for medication safety in urologic patients admitted to a hospital. Considerable shifts were seen in eGFR-categories when correctly calculating eGFRnon-indexed for drug dosing purposes. The fact that more than half of the study patients showed rDRP at hospital admission underlines the need to consider this risk factor appropriately. [ABSTRACT FROM AUTHOR]- Published
- 2020
- Full Text
- View/download PDF