Drug-related problems among chronic kidney disease patients: a clinical pharmacist led study

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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ANALISA DRUG RELATED PROBLEMS (DRPs) PADA PASIEN CHRONIC KIDNEY DISEASE (CKD) DI INSTALASI RAWAT INAP KLINIK SARI MEDIKA KABUPATEN SEMARANG

Jurnal Farmasi & Sains Indonesia ◽

10.52216/jfsi.v4i1.57 ◽

2021 ◽

Vol 4 (1) ◽

pp. 1-5

Author(s):

Poppy Diah Palupi ◽

Veronika Jayaningsih

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Health System ◽

Clinical Pathway ◽

Drug Related Problems ◽

Purposive Sampling ◽

Henry Ford

Drug Related Problems (DRPs) merupakan kejadian yang tidak diinginkan yang dialami oleh pasien dan berkaitan dengan pengobatan sehingga berpotensi mengganggu keberhasilan terapi. Penelitian ini bertujuan untuk mengetahui dan menganalisa DRPs yang terjadi pada pasien Chronic Kidney Disease (CKD) di instalasi rawat inap klinik Sari Medika kabupaten Semarang. Penelitian ini merupakan penelitian deskriptif dengan pengumpulan data secara retrospektif pada pasien CKD yang diperoleh dari data rekam medis. Pengambilan sampel menggunakan teknik purposive sampling. Acuan yang digunakan pada penelitian ini adalah Pharmacotherapy Handbook 9th edition 2015, Kidney Disease Improving Global Outcomes (KDIGO), The Renal Drug Handbook 3rd edition 2009, Panduan Praktik Klinis & Clinical Pathway Penyakit Jantung, Pembuluh Darah 2016, dan Henry Ford Health System 6th edition 2011. Hasil penelitian yang dilakukan pada 84 pasien CKD menunjukkan bahwa terdapat DRPs pada 66 pasien dengan kategori yaitu indikasi tanpa terapi (30.86%), terapi tanpa indikasi (6.17%), dosis sub terapi (1.23%), dosis obat berlebih (13.58%), pemilihan obat tidak tepat (45.68%), dan penderita gagal menerima obat (2.47%).

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