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Drug prescribing for patients with changing renal function
T G Cantú1, E F Ellerbeck, S W Yun
1Department of Pharmacy, Johns Hopkins Hospital (JHH), Baltimore, MD 21287.
American Journal of Hospital Pharmacy
|December 1, 1992
Summary
Renal dysfunction affects 5% of hospitalized patients, particularly the elderly. Many patients with renal impairment receive excessive drug dosages, highlighting the need for better physician alerts.
Area of Science:
- Nephrology
- Clinical Pharmacy
- Geriatrics
Background:
- Renal dysfunction is common in hospitalized patients.
- Older adults are disproportionately affected by impaired kidney function.
- Prescribing practices for renally eliminated drugs require careful consideration in this population.
Purpose of the Study:
- To determine the prevalence and course of renal dysfunction in hospitalized patients.
- To assess the appropriateness of prescribing renally eliminated drugs for patients with renal compromise.
- To identify potential risks associated with drug dosing in renally impaired inpatients.
Main Methods:
- Screening of adult inpatients for renal dysfunction (estimated creatinine clearance < 40 mL/min).
- Monitoring of renal function changes in compromised patients.
- Comparison of prescribed renally eliminated drug regimens with manufacturer recommendations.
Main Results:
- 195 (5%) of 3800 screened patients had renal dysfunction, mostly over 65 years old.
- 45% of renally compromised patients receiving renally eliminated drugs were given dosages exceeding recommendations.
- Elderly patients showed a lower likelihood of renal function improvement.
Conclusions:
- Hospitalized patients, especially the elderly, frequently experience renal dysfunction.
- A significant proportion of renally impaired patients receive potentially excessive drug dosages.
- Physician alert systems for renally eliminated drugs must account for dynamic changes in renal function.
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