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Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance01:25

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In healthy individuals, serum creatinine levels remain stable due to a balance between its constant production—primarily from muscle metabolism—and renal excretion. Creatinine is freely filtered by the glomeruli, making it a valuable marker for estimating renal function. When the glomerular filtration rate (GFR) decreases, the kidneys can only eliminate less creatinine, causing serum levels to rise.Serum creatinine concentration is widely used to estimate creatinine clearance...
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Factors Affecting Renal Clearance: Renal Impairment01:17

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Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
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Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant01:25

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In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...
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Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration01:28

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Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area.
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Renal Drug Clearance: Overview01:06

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Renal clearance is a crucial parameter in pharmacokinetics that quantifies the rate at which the kidneys excrete a drug. It represents a constant fraction of the central volume of distribution containing the drug that the kidney eliminates per unit of time.
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Renal Drug Clearance: Comparison Between Renal Excretion Methods01:08

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Renal clearance is a critical parameter encompassing kidney filtration, secretion, and reabsorption processes. It is calculated using a specific equation to determine the rate at which the kidneys clear a drug.
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Reducing prescribing errors through creatinine clearance alert redesign.

Brittany L Melton1, Alan J Zillich2, Scott A Russell3

  • 1School of Pharmacy, University of Kansas, Lawrence.

The American Journal of Medicine
|June 19, 2015
PubMed
Summary
This summary is machine-generated.

Redesigned creatinine clearance alerts significantly reduced prescribing errors by 43% compared to original alerts. Human factors principles improved alert usability and safer prescribing for patients with renal impairment.

Keywords:
Electronic health recordsEvaluationHealth information technologyPatient safetyRenal disease

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Area of Science:

  • Clinical Informatics
  • Human Factors Engineering
  • Pharmacovigilance

Background:

  • Computerized alerts can reduce prescribing errors.
  • Human factors principles may further enhance alert effectiveness.
  • Previous alerts for creatinine clearance had limitations.

Purpose of the Study:

  • To apply human factors principles to redesign creatinine clearance alerts.
  • To assess the usability and error reduction of redesigned alerts compared to original alerts.

Main Methods:

  • Twenty outpatient providers evaluated original and redesigned alerts in usability sessions.
  • Fictional patient scenarios with renal impairment were used.
  • Quantitative and qualitative data were collected on usability and errors.

Main Results:

  • Redesigned alerts reduced prescribing errors by 43% (P=.001).
  • Significant error reduction for allopurinol and ibuprofen.
  • Providers reported less confusion with redesigned alerts; lab access increased 3.5x.

Conclusions:

  • Redesigned alerts significantly improved prescribing outcomes despite high overall error rates.
  • This study offers evidence for designing safer alerts for renal impairment.
  • Human factors integration enhances clinical decision support systems.