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PS-040 Pharmaceutical evaluation of drug dosage adjustment according to renal function
  1. AM Jambrina1,
  2. E Ramió2,
  3. P Modamio1,
  4. M Aguas2,
  5. N El Hilali2,
  6. EL Mariño1
  1. 1University of Barcelona. Faculty of Pharmacy, Clinical Pharmacy and Pharmacotherapy Unit, Barcelona, Spain
  2. 2Idcsalud Hospital Universitari Sagrat Cor, Department of Pharmacy, Barcelona, Spain


Background A large number of elderly polymedicated inpatients suffer chronic kidney disease (CKD). Thus, it is imperative that accurate adjustments are made to avoid toxicities and other adverse drugs events.1

Purpose To determine the rate of inappropriate dosing in patients with CKD, to describe the most common drugs involved and to quantify the degree of acceptance of the pharmacist’s interventions.

Materials and methods Prospective, interventional study conducted for two months (July–August 2013) at a University Hospital without an electronic prescription program. Inclusion criteria were based on serum creatinine and estimated glomerular filtration rate <50 ml/min which was calculated using the 4-variable equation from the Modification of Diet in Renal Disease (MDRD) Study. Hospital prescriptions were reviewed and medicines adjustment recommendations concerning dose and frequency were provided to the appropriate physician by an interventional document. 48 h later, we checked to see if the pharmaceutical recommendation had been accepted.

Results 110 patients with CKD were included. A total of 1127 drugs were reviewed (mean: 10.3 ± 3.3 drugs per patient). 42.4% needed to be adjusted: 46.4% had not previously been adjusted, 20.1% were adjusted by the physician and 33.5% were drugs that needed an adjustment depending on all aspects of the patient’s clinical presentation. 49 dosing adjustment recommendations for 39 patients were made and 18 (36.7%) in 16 patients were accepted. The pharmaceutical classes with the highest number of interventions were antibiotics (51%), followed by NSAIDs (24.5%) and heparins (10.2%). The main antibiotics involved were amoxicillin-clavulanic acid (28%) and levofloxacin (44%).

Conclusions A large number of prescribed drugs needed to be adjusted, consisting primarily of antibiotics and NSAIDs. Less than half pharmaceutical recommendations were accepted despite our limitations, because we couldn’t be sure that our intervention document had reached the physician. These results could be considered as a first step to more effectively monitoring CKD care quality


  1. Belaiche S et al. J Nephrol 2012;25:558-65.

No conflict of interest.

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