scholarly journals Assessment of medication Dosage Adjustment in Hospitalized Patients with Chronic Kidney Disease

2020 ◽  
Author(s):  
Zair Hassan ◽  
Iftikhar Ali ◽  
Arslan Rahat Ullah ◽  
Raheel Ahmed ◽  
Shakeel Rehman ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Medical Records ◽  
Dose Adjustment ◽  
Dosage Adjustment ◽  
Inappropriate Medication ◽  
Final Analysis ◽  
Obstructive Nephropathy ◽  
Dosing Error ◽  
Medication Dosage

ABSTRACTBackgroundIn patients with renal impairment, inappropriate medication dosing can develop adverse drug reactions (ADRs) or ineffective therapy due to declined renal function. This necessitates proper renal dosing adjustment. Using a retrospective analysis of medical records, this study was proposed to evaluate medication dosage adjustment in hospitalized chronic kidney disease (CKD) patients.MethodsThis retrospective review of medical records was conducted at the Institute of Kidney Disease (IKD), Peshawar. It included all CKD patients hospitalized between June 01, 2019 and May 31, 2020 and receiving at least one medication that needed adjustment. Glomerular filtration rate was calculated using Renal Disease Diet Modification (RDDM) equation, and dose suitability was established by evaluating practice with relevant guidelines.ResultsOf the total 1537 CKD patients, 231(15.03%) had evidence of dosing error, which were considered for final analysis. Overall, 1549 drugs were prescribed, 480(30.99%) drugs required dose adjustment of which 196(40.42%) were adjusted properly and the remaining 286(59.58%) were unadjusted. The most common unadjusted drugs were meropenem, cefepime, ciprofloxacin and rosuvastatin, whereas captopril, aspirin, bisoprolol, pregabalin and levofloxacin had the highest percentage of adjusted drugs. On multivariate logistic regression, the number of drugs requiring dosing adjustments and obstructive nephropathy were found to be statistically significant factors that increased the likelihood of the medication dosing errors: A unit increase in the number of drugs requiring dose adjustment increases 5.241 times the likelihood of dosing error. Similarly the presence of obstructive nephropathy (Odds ratio (OR) 0.383, 95% confidence interval (Cl) [0.153-0.960] P= 0.041) was found to be significantly associated with dosing error after adjustment for potential confounding factors.ConclusionThe dosing of more than half of the prescribed drugs that required adjustment in CKD were not adjusted which showed that medication dosing errors were high. This highlights the importance of medication prescription according to guidelines in CKD patients to improve the outcomes of pharmacotherapy and patients’ quality of life.

scholarly journals Assessment of Medication Dosage Adjustment in Hospitalized Patients With Chronic Kidney Disease

Cureus ◽  
2021 ◽  
Author(s):  
Zair Hassan ◽  
Iftikhar Ali ◽  
Arslan R Ullah ◽  
Raheel Ahmed ◽  
Adnan Zar ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Dosage Adjustment ◽  
Hospitalized Patients ◽  
Medication Dosage

scholarly journals Drug Dosage Adjustment of Chronic Kidney disease Patients at Nephrology Ward in Tertiary Care Hospital of Nepal

2020 ◽  
Vol 2 (1) ◽  
pp. 41-50
Author(s):  
Sonu Pakhrin ◽  
Sumitra Shrestha ◽  
Renu Karki ◽  
Nirmal Raj Marasine ◽  
Rajendra Lama ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Dose Adjustment ◽  
Dosage Adjustment ◽  
Tertiary Care ◽  
College Teaching ◽  
Drug Dosage ◽  
Care Hospital ◽  
Laboratory Findings ◽  
Drug Dosage Adjustment

Background: Drug dosage adjustment is essential for chronic kidney disease patients (CKD) patients. If it is not done properly, this will lead to an increase in toxicity and a decrease in the effectiveness of therapy. The objective of the present study was to assess whether appropriate dosage adjustments were made in hospitalized CKD patients. Methods: A descriptive cross-sectional study was carried out among 80 CKD patients with stage II to V admitted in the nephrology ward of Chitwan Medical College Teaching Hospital, Nepal between 1st August to 30th November 2018. All patients with renal clearance ≤90 ml/min/1.73 m2 were included for the analysis. Data concerning patient’s clinical, medications and dosages, laboratory findings were extracted from the medical record section. Results: Total of 81 numbers of prescribed drugs was found in eighty hospitalized CKD patients. Twenty-seven were found requiring dose adjustment. Dose adjustment according to renal function was judged as necessary in 27 dose adjustment required drugs. Among these, 11 (40.7% of 27) drugs were considered appropriate in dosing, whereas 16 (59.3%) were found to be inappropriate. A total of 13 (81.3%) number of drugs were inappropriately adjusted in stage V patients. Conclusion: Dosing errors were the most frequently observed challenge in the patient hospitalized with CKD. This study also intensified the need for strong monitoring of drug therapy which will bear in achieving the better therapeutic outcomes that improve the quality of life and decrease the various problems associated with dosing error. 

scholarly journals Gambaran Pasien yang Menjalani Prosedur Bedah Emergensi di RSUP Prof. Dr. R. D. Kandou Manado Periode Januari - September 2019

e-CliniC ◽  
2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Utrecht Suleman ◽  
Angelica M. J. Wagiu ◽  
Stephanus J. Ch. Tangel
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Surgical Procedures ◽  
Emergency Surgery ◽  
Medical Records ◽  
Health Centers ◽  
Surgical Patients ◽  
Age Group ◽  
Adult Age ◽  
Epidural Hemorrhage

Abstract: Emergency surgery is performed to avoid further complications of the disease or to save the patient's life. Albeit, there are lack of data in various health centers in Indonesia regarding the evaluation of emergency surgical patients, This study was aimed to obtain the profile of patients undergoing emergency surgical procedures in the Emergency Department of Surgery at Prof. Dr. R. D. Kandou Hospital Manado from January to September 2019. This was a retrospective and descriptive study using patients’ medical records. The results showed that there were 540 patients in this study. Most of the patients were adult age group (18-59 years) as many as 343 patients (63.5%), males 366 patients (67.8%), and non-traumatic cases 436 patients (80.4%). The most common cases of trauma was epidural hemorrhage as many as 23 patients (4.3%) meanwhile the most common non-traumatic cases was chronic kidney disease as many as 122 patients (22.6%). According to the type of surgery, CDL insertion and laparotomy were performed on 131 patients each (24.3%). In conclusion, most patients undergoing emergency surgical procedures were 18-59 years old, males, and non-traumatic cases.Keywords: emergency surgery, traumatic cases, non-traumatic cases Abstrak: Bedah emergensi dilakukan dalam keadaan sangat darurat untuk menghindari komplikasi lanjut dari proses penyakit atau untuk menyelamatkan jiwa pasien. Data mengenai pasien bedah emergensi di berbagai pusat kesehatan di Indonesia masih sangat kurang. Penelitian ini bertujuan untuk mendapatkan gambaran pasien yang menjalani prosedur bedah emergensi di IGD Bedah RSUP Prof. Dr. R. D. Kandou Manado periode Januari sampai September 2019. Jenis penelitian ialah deskriptif retrospektif, menggunakan data rekam medik pasien. Hasil penelitian menunjukkan bahwa dari 540 pasien, didapatkan pasien terbanyak dari golongan usia dewasa (18-59 tahun) yaitu 343 pasien (63,5%), jenis kelamin laki-laki 366 pasien (67,8%), dan kasus non-trauma 436 pasien (80,4%). Kasus trauma terbanyak yaitu epidural hemorrhage pada 23 pasien (4,3%) sedangkan kasus non trauma terbanyak chronic kidney disease pada 122 pasien (22,6%). Menurut jenis tindakan operasi yang terbanyak ialah insersi CDL dan laparotomy, masing-masing 131 pasien (24,3%). Simpulan penelitian ini ialah pasien yang menjalani prosedur bedah emergensi terbanyak ialah usia 18-59 tahun, jenis kelamin laki-laki, dan jenis kasus non-trauma.Kata kunci: bedah emergensi, kasus trauma, kasus non-trauma

scholarly journals Gambaran Anemia pada Subjek Penyakit Ginjal Kronik Stadium 4 dan 5 di Poliklinik Ginjal-Hipertensi RSUP Prof. Dr. R. D. Kandou

e-CliniC ◽  
2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Yordhan Tamsil ◽  
Emma Sy. Moeis ◽  
Frans Wantania
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Medical Records ◽  
Iron Status ◽  
Descriptive Study ◽  
Transfusion Therapy ◽  
Female Age ◽  
Stage 4 ◽  
Almost All ◽  
Age Range

Abstract: Anemia is a complication of chronic kidney disease (CKD) that often occurs. Moreover, it can occur earlier than other complications of CKD in almost all patients with late stage kidney disease. This study was aimed to obtain the profile of anemia in subjects with stage 4 and 5 of chronic kidney disease. This was a retrospective and descriptive study using medical records of patients with CKD associated with anemia for two years. The results showed that of 428 CKD patients, 131 suffered from anemia (30.60%). The majority of patients were female (54.19%), age range 60-69 years (44.27%), non-dialysis stage 5 of CKD patients (74.04%), had sufficient iron status (79.38%). However, 15,26% of the 131 patients got blood transfusion therapy. In conclusion, the majority of CKD patients were stage 5 ND, female, age range of 60-69 years, had sufficient iron status, and were not treated with blood transfusion.Keywords: chronic kidney disease, anemia Abstrak: Anemia merupakan komplikasi penyakit ginjal kronik (PGK) yang sering terjadi, bahkan dapat terjadi lebih awal dibandingkan komplikasi PGK lainnya dan hampir pada semua pasien penyakit ginjal tahap akhir. Penelitian ini bertujuan untuk mengetahui gambaran anemia pada subyek penyakit ginjal kronik stadium 4 dan 5 di Poliklinik Ginjal-Hipertensi RSUP Prof. Dr. R. D. Kandou. Jenis penelitian ialah metode deskriptif retroskpektif dengan mengunakan data rekam medik pasien PGK dengan anemia selama dua tahun. Hasil penelitian memperlihatkan dari 428 pasien PGK didapatkan 131 pasien dengan anemia pada PGK (30,60%). Mayoritas pasien ialah jenis kelamin perempuan (54,19%), usia 60-69 tahun (44,27%), dan PGK derajat 5 non-dialisis (74,04%), memiliki status besi cukup (79,38%). Terdapat 15,26% dari pasien yang mendapatkan terapi transfusi darah. Simpulan penelitian ini ialah pasien terbanyak dengan derajat 5 ND, jenis kelamin perempuan, rentang usia 60-69 tahun, dengan status besi cukup, dan tidak mendapat terapi transfusi darah.Kata kunci: penyakit ginjal kronik, anemia

scholarly journals Penyesuaian Dosis Obat pada Pasien Gagal Ginjal Kronis Rawat Inap di Rumah Sakit Kabupaten Tegal, Indonesia

2021 ◽  
Vol 17 (1) ◽  
pp. 46
Author(s):  
Santi Andriani ◽  
Fita Rahmawati ◽  
Tri Murti Andayani
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Dose Adjustment ◽  
Cross Sectional

Pemberian obat dengan dosis sesuai pada pasien Chronic Kidney Disease  (CKD ) penting dilakukan, salah satunya untuk memastikan luaran terapi obat yang optimal. Penelitian ini bertujuan mengetahui hubungan antara dose adjustment obat dan luaran terapi serta efisiensi biaya terapi obat dengan adanya dose adjustment pada pasien rawat inap dengan CKD.Jenis penelitian ini observasional dengan desain cross sectional. Sebanyak 200 rekam medis pasien rawat inap dengan CKD periode Januari – Desember 2017 di RSUD dr. Soeselo dan RSUD Suradadi Kabupaten Tegal dilibatkan dalam penelitian ini. Dose adjustment dihitung berdasarkan fungsi ginjal pasien, yang diestimasikan dengan laju filtrasi glomerular menggunakan formula Cockcroft-Gault. Hubungan antara dose adjustment obat dan luaran terapi menggunakan analisis Chi-square.Hasil penelitian menunjukkan terdapat 1882 obat yang diresepkan, 338 (17,93%) obat memerlukan dose adjustment pada pasien CKD. Dari  obat tersebut, 175 (51,78%) obat diberikan dengan dose adjustment,  sejumlah 118 (67,43%) obat menghasilkan luaran terapi membaik , 23 (15,52%)  obat tidak membaik  dan 34 (19,43%) obat tidak dapat dievaluasi. Sedangkan dari 163 obat tanpa dose adjustment, 103 (63,19%) obat menghasilkan luaran terapi membaik dan 40 (24,54%) obat tidak membaik dan 20 (12,27%) obat tidak dapat dievaluasi. Terdapat hubungan yang signifikan antara dose adjustment dengan luaran terapi obat pada pasien rawat inap dengan CKD (OR 1,922, 95% CI = 1,119-3,548, p= 0,018). Efisiensi biaya yang dapat dihasilkan dengan adanya dose adjusment pada penelitian ini sebesar Rp. 1.620.588,00.

Obstructive nephropathy and chronic kidney disease secondary to uterine leiomyomas

2008 ◽  
Vol 279 (6) ◽  
pp. 785-788 ◽  
Author(s):  
T. Bansal ◽  
P. Mehrotra ◽  
D. Jayasena ◽  
S. Okolo ◽  
W. Yoong ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Uterine Leiomyomas ◽  
Obstructive Nephropathy

CP-057 Dosage adjustment of epoetin β and darbepoetin α in chronic kidney disease

2015 ◽  
Vol 22 (Suppl 1) ◽  
pp. A22.2-A22
Author(s):  
C Pérez Diez ◽  
H Navarro ◽  
N De la Llama ◽  
J Pérez-Pérez ◽  
I Navarro ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Dosage Adjustment

Medications Used Routinely in Primary Care to be Dose-Adjusted or Avoided in People With Chronic Kidney Disease: Results of a Modified Delphi Study

2020 ◽  
Vol 54 (7) ◽  
pp. 625-632 ◽  
Author(s):  
Leena Taji ◽  
Marisa Battistella ◽  
Allan K. Grill ◽  
Jessie Cunningham ◽  
Brenda L. Hemmelgarn ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Delphi Study ◽  
Dose Adjustment ◽  
Sglt2 Inhibitor ◽  
Primary Care Providers ◽  
Delphi Panel ◽  
Care Providers ◽  
Modified Delphi

Background: Chronic kidney disease (CKD) affects up to 18% of those over the age of 65 years. Potentially inappropriate medication prescribing in people with CKD is common. Objectives: Develop a pragmatic list of medications used in primary care that required dose adjustment or avoidance in people with CKD, using a modified Delphi panel approach, followed by a consensus workshop. Methods: We conducted a comprehensive literature search to identify potential medications. A group of 17 experts participated in a 3-round modified Delphi panel to identify medications for inclusion. A subsequent consensus workshop of 8 experts reviewed this list to prioritize medications for the development of point-of-care knowledge translation materials for primary care. Results: After a comprehensive literature review, 59 medications were included for consideration by the Delphi panel, with a further 10 medications added after the initial round. On completion of the 3 Delphi rounds, 66 unique medications remained, 63 requiring dose adjustment and 16 medications requiring avoidance in one or more estimated glomerular filtration rate categories. The consensus workshop prioritized this list further to 24 medications that must be dose-adjusted or avoided, including baclofen, metformin, and digoxin, as well as the newer SGLT2 inhibitor agents. Conclusion and Relevance: We have developed a concise list of 24 medications commonly used in primary care that should be dose-adjusted or avoided in people with CKD to reduce harm. This list incorporates new and frequently prescribed medications and will inform an updated, easy to access source for primary care providers.

scholarly journals Pharmacotherapy assessment in chronic kidney disease: validation of the pair instrument for use in Brazil

2020 ◽  
Author(s):  
Alessandra Batista Marquito ◽  
Hélady Sanders Pinheiro ◽  
Natália Maria da Silva Fernandes ◽  
Rogério Baumgratz de Paula
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Judgment ◽  
Medical Records ◽  
Chronic Renal Disease ◽  
Drug Related Problems ◽  
Longitudinal Observational Study ◽  
Clinically Significant ◽  
Validated Instrument ◽  
Level Of Agreement

Abstract Individuals with chronic kidney disease (CKD) use polypharmacy, which, in combination with renal impairment, exposes them to the risk of drug-related problems (DRPs). There are no available tools in Brazil to systematically assess the pharmacotherapy and management of DRPs in this population. Therefore, the objective of this work was to validate the PAIR instrument (Pharmacotherapy Assessment in Chronic Renal Disease) for use in Brazilian Portuguese. This is a retrospective longitudinal observational study. Medical records from 100 CKD patients under conservative treatment, between 2016 and 2017, in a nephrology clinic, were analyzed. PAIR was applied by pharmacists in two consultations of the same patient, with an interval of 6 months. Reliability, conceptual validity, responsiveness of the instrument and prevalence of DRPs in the studied sample were assessed. A mean of 1.26 ± 0.96 DRPs/patient was identified. Inter-rater reliability coefficients (k) ranged from 0.58 to 0.94 and from 0.79 to 1.00 for test-retest, revealing moderate to perfect level of agreement. In conceptual validity, a mean of 1.60 ± 1.24 DRPs/patient was identified by the nephrologist through clinical judgment, compared to 1.33±0.76 DRPs/patient identified by the pharmacist using PAIR (p = 0.07). Therefore PAIR allowed the identification of clinically significant DRPs. In responsiveness, a mean of 1.26 ± 0.96 DRPs/patient was identified at the first consultation and 1.11 ± 1.02 DRPs/patient at the subsequent consultation (p = 0.17) by the pharmacist using PAIR. The number of DRPs between the periods did not change. As a conclusion, the PAIR allowed the identification of clinically significant DRPs in CKD, constituting a new validated instrument to be used in Brazil.

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