Sweileh Waleed M, Janem Samah A, Sawalha Ansam F, Abu-Taha Adham S, Zyoud Sa'ed H, Sabri Iyad A, Al-Jabi Samah W, Jaradat Nidal A, Zaid Abed Al-Naser M
College of Pharmacy, An-Najah National University, Nablus, Palestine.
Pharmacoepidemiol Drug Saf. 2007 Aug;16(8):908-12. doi: 10.1002/pds.1412.
Reduced renal function requires dose adjustment for certain drugs to avoid toxicity. The aim of this study was to determine whether appropriate dosage adjustments were made for drugs that are nephrotoxic, excreted, or metabolized (TEM medications) by the kidney in patients with renal impairment.
A cross-sectional study of a group of hospitalized patients was carried out at Al-Watni governmental hospital, Nablus, Palestine. All patients with creatinine clearance </=59 ml/min were included in the analysis. Data regarding patients' clinical, laboratory findings and medications whether they were prescribed at hospital or at discharge were collected from patients' medical files. Evaluation of appropriate dosing was based on Physician Disk Reference (PDR). All data were collected for further research and subsequent statistical analysis using statistical package for social sciences (SPSS) for windows version 10.
A total of 78 patients had calculated creatinine clearance </=59 ml/min. Those patients were prescribed a total of 1001 lines of prescription medication. Dosage adjustment was necessary for 193 TEM medications. Analysis of TEM medications with guidelines for adjustment indicated that 73.58%(142) were found to be inappropriate and 26.42% (51) were found to be appropriate. The most common inappropriate medications were ranitidine, antibiotics, and digoxin. Approximately 77.5% of the unadjusted medications were prescribed during hospitalization.
In our study, a wide range of dosing errors was common among patients with renal impairment that was common during hospitalization. Continued medical education in the field of clinical pharmacokinetics is important for physicians.
肾功能减退时，某些药物需要调整剂量以避免毒性。本研究的目的是确定肾功能损害患者中，对于通过肾脏排泄、代谢或具有肾毒性的药物（TEM药物）是否进行了适当的剂量调整。
在巴勒斯坦纳布卢斯的Al-Watni政府医院对一组住院患者进行了横断面研究。所有肌酐清除率≤59 ml/min的患者均纳入分析。从患者的病历中收集有关患者临床、实验室检查结果以及药物（无论在住院期间还是出院时开具）的数据。基于医师案头参考（PDR）对适当剂量进行评估。所有数据均收集用于进一步研究，并使用Windows版社会科学统计软件包（SPSS）10.0进行后续统计分析。
共有78例患者计算出的肌酐清除率≤59 ml/min。这些患者共开具了1001行处方药。193种TEM药物需要调整剂量。根据调整指南对TEM药物进行分析表明，73.58%（142种）被发现不合适，26.42%（51种）被发现合适。最常见的不合适药物是雷尼替丁、抗生素和地高辛。约77.5%未调整剂量的药物是在住院期间开具的。
在我们的研究中，肾功能损害患者中广泛存在剂量错误，这在住院期间很常见。临床药代动力学领域的持续医学教育对医生很重要。
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