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Published on: March 11, 2016
Evaluation of dosage adjustment in patients with renal impairment
P I Pillans1, P G Landsberg, A M Fleming
1Department of Clinical Pharmacology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. peter_pillans@health.qld.gov.au
Aims:
To determine whether appropriate dosage adjustments are made in patients with significant renal impairment for drugs with a high fractional renal clearance.
Methods:
Evaluation of dosage adjustment was performed in patients who were admitted to a 480-bed metropolitan hospital (Princess Alexandra Hospital, Brisbane, Australia) with an estimated creatinine clearance of < or =40 mL/min. All drugs had a high fractional renal excretion. A prescribed dose within 30% of the calculated dose was considered appropriate.
Results:
Doses were found to be inappropriately high in 111 (44.8%) of 248 admission prescriptions of the targeted drugs. Doses were appropriately reduced in hospital in 26 patients (23.4%). Seventy-three (29.3%) prescriptions were continued with excessive doses. Only 34 prescriptions for the target drugs were initiated in hospital, of which 88.2% were appropriately dosed.
Conclusions:
A significant percentage of patients with renal impairment are admitted to hospital on inappropriately high doses of drugs, with a high fractional renal excretion and low therapeutic index. Doses are appropriately reduced in hospital in some patients but there is still room for improvement [corrected].
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