A study of drug dosing adjustment initiative in patients with renal impairment admitted to internal medicine wards

Abstract

Introduction: Drug  dosing  errors  are  common  in  renally  impaired  patients.  Appropriate dosage adjustment is important to ensure patient safety and to avoid adverse drug effects or poor outcomes.  The  objective  of  the  present  study  was  to assess  the  pattern  and  number  of  the inappropriate  dosage  adjustment  in  hospitalized  patients  with  renal  impairment  to  improve  future renal dosage adjustment guidance. Methods: The prospective study was conducted in patients with renal impairment from August to October 2016 at Internal Medicine wards of the Sunprasittiprasong Hospital.  Inappropriate  dosage  adjustment  was  reported  by  using  descriptive  statistics. Results: 1,235 patients were evaluated. The study found 180 patients (14.6%) had renal impairment. 21out of 180 patients (11.7%) with  renal impairment received  inappropriate dosage regimens.  The study also found that 232 medications required dosage adjustment. 211 (90.9%) medications were renally adjusted appropriately  while 21 (9.1%) were inappropriately adjusted. Of  the 21  pharmacist recommendations,  physicians  accepted  a  total  of  14 (66.7%). Conclusion: The  study  identified  a number  of  renal  impaired  subjects  who  received  inappropriate  dosage  regimens. The  two  most common drug classes that were not renally adjusted appropriately are antibiotics and cardiovascular drugs.  Therefore,  this  renal  dosage  guidance  may  be useful  to  improve  future  renal  dosage guidance to be used in other medical units.