[Pharmaceutical care in renal insufficiency inpatients]

To asses the outcomes of posological adjust program in renal impairment inpatients, describe the drugs more usually involved, and determine the degree of acceptance of the pharmaceutical intervention made.

A fifteen months-prospective study, in renal insufficiency inpatients (serum creatinine > 1,4 mg/dL) treated with drugs that needs posological adjustment. The primary outcome was the ratio of adequate dosage of the treatment, according with the glomerular filtration rate. We also evaluated the global acceptation rate, the drugs inadequate prescribed more frequently, phamacokinetic analysis derived from the pharmaceutical intervention and its educative character.

384 patients were identified, and 341 of them presented a glomerular filtration rate between 10-50 ml/min. 2.807 prescribed drugs were reviewed, and 2.052 of them didn%#39;t require posological adjustment in renal insufficiency, 508 prescribed drugs were correctly adjusted. 247 pres - criptions were susceptible of posological adjustment and 164 of them, needed a concrete posological adjustment. We performed 200 posological recommendations, and 131 were accepted. The drugs with a higher number of interventions were enoxaparine, levofloxacin, amoxicillin-clavulanic and digoxin.

The implementation of the pharmaceutical care program was accepted between physicians, being antibiotics the group more susceptible of doing a posological adjustment in most patients with renal impairment.