Analysis of drug dosing adjustments in patients with chronic kidney disease

Chronic kidney disease is the presence of kidney damage or a reduction in the glomerular filtration rate (GFR) for three months or longer. Patients with renal impairment often show pharmacokinetic parameters that are different from those of patients with normal renal function. Drug-related problems are common in patients with renal insufficiency and in those undergoing hemodialysis. Proper dosing can maximize therapeutic efficacy, minimize toxicity, and decrease the workload for nurses. It can also have an economic impact, resulting in the elimination of costs associated with drug-related toxicity and savings in terms of drug costs. The aim of the study was to investigate the appropriate dosage adjustment of CKD patients in the hospitals of Islamabad and estimate need of clinical pharmacist. Expenditure that could be reduced with proper dosage adjustment for CKD patients was also calculated. This study was conducted in two public and two private Hospitals of Islamabad. Prescriptions of patients having a creatinine above 1.5 mg/dl were analyzed. We considered the appropriateness of prescriptions for medications having potential nephrotoxicity and/or eliminated through renal excretion or metabolism (TEM medications). Cost-effectiveness of dosage adjustment was also evaluated. 60% of the prescriptions contained medication with potential nephrotoxicity and/or renal elimination or metabolism. 50% of the prescriptions were inappropriate, with 45% indicating inappropriate dosage with regard to the patientu0027s renal function and 5% being contra-indicated orders. 100% of the private hospital prescriptions were adjusted and 100% of the government hospital prescriptions were not adjusted. In overdosed medications, which were not adjusted, 58% of the cost was reduced after adjusting the proper dose according to the patient