Background The use of drugs in patients with nephropathy carries certain risks. Therefore, dosages must be adjusted.
Purpose To describe pharmaceutical interventions (PIs) on electronic prescriptions for patients with renal impairment (RI = creatinine clearance <50 ml/min) admitted from emergencies.
Materials and Methods Nine-month observational study performed with patients with RI admitted from emergencies to wards with electronic prescribing. Glomerular filtration rate was calculated with MDRD-4 IDMS. Treatments were reviewed to evaluate the suitability of doses using the data sheets Medimecum, Micromedex and Lexicomp. If the dose was not correct, a PI was written in the ‘Alerts’ section of the prescribing programme which was subsequently seen by the physician. Demographics, date of the PI, serum creatinine, creatinine clearance, drug, PI, acceptance or rejection and why and evolution of renal function on the seventh day of the acceptance were recorded in the database.
Results 5311 patients were included, 221 PIs were made for 181 patients (3.41%). Patients for whom interventions were made had a mean age of 78 (29–102) and 49.2% were male. The drug with most interventions was levofloxacin (29.9%). The PIs were: dose-related (65.6%), increase of therapeutic range (26.7%) and contraindication (7.2%). 65.6% were accepted. The clinical consequences after acceptance of the PI were: improved renal function (54.5%), deteriorated (12.4%), unchanged (11.0%) or not evaluable (22.1%). In patients whose PI was rejected, renal function improved in 57.63%, deteriorated in 16.95%, was unchanged in 6.78 and not evaluable in 18.64%. A Chi-square test was applied to study whether the evolution of renal function depended on acceptance (p value 0.634).
Conclusions Electronic prescribing is a useful tool for identifying opportunities for PI in patients with RI. Differences in renal function progression between the group in which the PI were accepted and the group in which these were rejected were not statistically significant.
No conflict of interest.
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