Background To ensure the effectiveness and/or avoid the toxicity of drugs with narrow therapeutic and/or renal elimination margins, it is essential to adjust the dose according to glomerular filtration rate (GFR). To collaborate in such patient care activities, a growing number of acute care hospitals have pharmacists participating in ambulatory care clinics and hospital based home healthcare services.
Purpose To assess the adequacy of medicines prescribed in our health district in patients with decreased GFR.
Material and methods This was a retrospective observational study. Field of study: two tertiary hospitals and their reference areas. The target population consisted of 666 000 people. Study population: patients with a serum creatinine (SC) determination in our health district in February 2016. Inclusion criteria: >18 years with GFR <45 mL/min/1.73m2. Exclusion criteria: patients whose characteristics made them unsuitable to use the CKD-EPI formula to calculate GFR. GFR was calculated from the SC provided by the laboratory. Through the electronic medical records, prescribed doses of the medications that needed dosage adjustment were recorded. Correct doses according to GFR of these medications were also recorded. Data on prescription changes made by the primary care physicians (GP) were collected. ATC groups were studied. Adequacy of the prescriptions was calculated as: (prescriptions adjusted correctly according to GFR)/(total number of prescriptions susceptible to modification).
Results 116 patients (76.7% women) with a mean age of 80.8 years were included. 73.3% of patients had GFR ( mL/min/1.73m2) between 30 and 44; 24.1% between 15 and 29 and 2.6% <15. 52.6% of patients had prescriptions suitable for adjustment (93 prescriptions in total), but only 11.8% (11) of the prescriptions were modified by the corresponding GP. The ATC groups that needed adjustment more frequently were A10A (25.8%), A10B (23.65%) and B01A (10.75%). Only 10.75% of prescriptions were adequate.
Conclusion The adequacy of medicines prescribed in our health district in patients with decreased GFR was very low. More than half of patients with a GFR <45 mL/min/1.73m2 needed adjustment in at least one of their medications, as very few prescriptions were adjusted by their corresponding GP.
No conflict of interest
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