Dosage adjustment in medical patients with renal impairment at Groote Schuur Hospital

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dc.contributor.authorDecloedt, Eric
dc.contributor.authorLeisegang, Rory
dc.contributor.authorBlockman, Marc
dc.contributor.authorCohen, Karen
dc.date.accessioned2021-10-08T07:17:57Z
dc.date.available2021-10-08T07:17:57Z
dc.date.issued2010
dc.description.abstractBACKGROUND: Many drugs are eliminated by the kidneys and therefore may require dose adjustment in patients with renal impairment. The need for dose adjustment is frequently neglected by prescribers. METHODS: We reviewed folders of patients admitted to the Groote Schuur Hospital general medical wards between January and March 2008. Patients with renal impairment, defined as an estimated glomerular filtration rate (eGFR) < or = 50 ml per minute per 1.73 m2, were identified. In-patient prescriptions were captured if they were written after clinical notes indicated impaired renal function, or > or = 1 day after renal function tests were performed. We determined what proportion of these prescriptions required dose adjustment and whether drug doses were appropriately adjusted. RESULTS: We found renal impairment in 32% (97/301) of medical admissions. There were 615 prescription entries for the 97 patients with renal impairment. Dose adjustment was required in 19% (117/615) of prescription entries, and only 32% (37/117) of these prescription entries were correctly dose adjusted. Of 97 patients, 69 received one or more drugs that required dose adjustment (median 1, range 1 - 5). All drug doses were correctly adjusted in 12% (8/69) of patients. Importantly, in the majority of patients (59% (41/69)) no doses had been correctly adjusted. CONCLUSION: Consistent with international studies, drug dose adjustment in patients with renal impairment in a South African hospital was frequently neglected. Strategies to alert clinicians of the need for dose adjustment in renal impairment should be considered, including automated eGFR reporting and computerised aids to guide drug dosing, that account for renal impairment.
dc.identifier.apacitationDecloedt, E., Leisegang, R., Blockman, M., & Cohen, K. (2010). Dosage adjustment in medical patients with renal impairment at Groote Schuur Hospital. <i>South African Medical Journal</i>, 100(5), 304 - 177. http://hdl.handle.net/11427/34870en_ZA
dc.identifier.chicagocitationDecloedt, Eric, Rory Leisegang, Marc Blockman, and Karen Cohen "Dosage adjustment in medical patients with renal impairment at Groote Schuur Hospital." <i>South African Medical Journal</i> 100, 5. (2010): 304 - 177. http://hdl.handle.net/11427/34870en_ZA
dc.identifier.citationDecloedt, E., Leisegang, R., Blockman, M. & Cohen, K. 2010. Dosage adjustment in medical patients with renal impairment at Groote Schuur Hospital. <i>South African Medical Journal.</i> 100(5):304 - 177. http://hdl.handle.net/11427/34870en_ZA
dc.identifier.issn0038-2469
dc.identifier.ris TY - Journal Article AU - Decloedt, Eric AU - Leisegang, Rory AU - Blockman, Marc AU - Cohen, Karen AB - BACKGROUND: Many drugs are eliminated by the kidneys and therefore may require dose adjustment in patients with renal impairment. The need for dose adjustment is frequently neglected by prescribers. METHODS: We reviewed folders of patients admitted to the Groote Schuur Hospital general medical wards between January and March 2008. Patients with renal impairment, defined as an estimated glomerular filtration rate (eGFR) < or = 50 ml per minute per 1.73 m2, were identified. In-patient prescriptions were captured if they were written after clinical notes indicated impaired renal function, or > or = 1 day after renal function tests were performed. We determined what proportion of these prescriptions required dose adjustment and whether drug doses were appropriately adjusted. RESULTS: We found renal impairment in 32% (97/301) of medical admissions. There were 615 prescription entries for the 97 patients with renal impairment. Dose adjustment was required in 19% (117/615) of prescription entries, and only 32% (37/117) of these prescription entries were correctly dose adjusted. Of 97 patients, 69 received one or more drugs that required dose adjustment (median 1, range 1 - 5). All drug doses were correctly adjusted in 12% (8/69) of patients. Importantly, in the majority of patients (59% (41/69)) no doses had been correctly adjusted. CONCLUSION: Consistent with international studies, drug dose adjustment in patients with renal impairment in a South African hospital was frequently neglected. Strategies to alert clinicians of the need for dose adjustment in renal impairment should be considered, including automated eGFR reporting and computerised aids to guide drug dosing, that account for renal impairment. DA - 2010 DB - OpenUCT DP - University of Cape Town IS - 5 J1 - South African Medical Journal LK - https://open.uct.ac.za PY - 2010 SM - 0038-2469 T1 - Dosage adjustment in medical patients with renal impairment at Groote Schuur Hospital TI - Dosage adjustment in medical patients with renal impairment at Groote Schuur Hospital UR - http://hdl.handle.net/11427/34870 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34870
dc.identifier.vancouvercitationDecloedt E, Leisegang R, Blockman M, Cohen K. Dosage adjustment in medical patients with renal impairment at Groote Schuur Hospital. South African Medical Journal. 2010;100(5):304 - 177. http://hdl.handle.net/11427/34870.en_ZA
dc.language.isoeng
dc.publisher.departmentDivision of Clinical Pharmacology
dc.publisher.facultyFaculty of Health Sciences
dc.sourceSouth African Medical Journal
dc.source.journalissue5
dc.source.journalvolume100
dc.source.pagination304 - 177
dc.source.urihttps://dx.doi.org/10.7196/SAMJ.3955
dc.subject.otherHuman
dc.subject.otherTropical medicine
dc.subject.otherHospital
dc.subject.otherDosage adjustment
dc.subject.otherRenal failure
dc.subject.otherKidney disease
dc.subject.otherUrinary system disease
dc.subject.otherHomme
dc.subject.otherMédecine tropicale
dc.subject.otherHôpital
dc.subject.otherAdaptation posologie
dc.subject.otherInsuffisance rénale
dc.subject.otherPathologie du rein
dc.subject.otherPathologie de l'appareil urinaire
dc.subject.otherHombre
dc.subject.otherMedicina tropical
dc.subject.otherAdaptación posología
dc.subject.otherInsuficiencia renal
dc.subject.otherRiñón patología
dc.subject.otherAparato urinario patología
dc.titleDosage adjustment in medical patients with renal impairment at Groote Schuur Hospital
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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