Drugs used in patients with renal impairment at Sunpasittiprasong Hospital: A retrospective study
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Introduction: Renal impairment alters drug pharmacokinetics, plasma drug levels, drug interactions, and adverse reactions, which are related to the accumulation of renally excreted drugs. Thus, appropriate dose adjustment is required in patients with reduced renal function to avoid any drug interactions and unwanted outcomes. The aim of this study was to assess whether appropriate dosage adjustment was made to the medications prescribed in hospitalized patients with renal impairment. Methods: A retrospective study was carried out on the Internal Medicine wards of Sunpasittiprasong Hospital. We included 18 year-old or older patients admitted to the hospital with 2 eGFR < 60 ml/min/1.73m or experiencing acute kidney injury by AKIN criteria from January to December 2015. Also, each patient must have received at least one drug that requires renal dosage adjustment. Potentially inappropriate renal dosage adjustment was reported by using descriptive statistic, frequency and percentage. Results: Our study identified 674 of 2326 drugs (29.0%) from a total of 236 patients in whom dosage adjustment was required. 173 (25.7%) items were not renally adjusted, such as acyclovir gabapentin and tenofovir. 486 (72.1%) items were adjusted appropriately and 15 (2.2%) items were found to have potentially inappropriate dosage adjustment, including cefdinir 100%, cefazolin and imipenem each 20% when compared to their prescribing rate. Conclusion: Despite laboratory results indicating reduced kidney function, inappropriate renal dose adjustment still occurs. In order to enhance patient safety, especially in patients with renal impairment, this study suggests that promoting proper drug use and the development of electronic tools can assist the medical staff to provide the safest care to patients.
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