Altunbas Gokhan, Yazc Mehmet, Solak Yalcin, Gul Enes E, Kayrak Mehmet, Kaya Zeynettin, Akilli Hakan, Aribas Alpay, Gaipov Abduzhappar, Yazc Raziye, Ozdemir Kurtulus
Departments of 1Cardiology and 2Nephrology, Konya Necmettin Erbakan University, Meram School of Medicine, Meram, Konya, Turkey; and 3Department of Nephrology, Konya Teaching and Research Hospital, Konya, Turkey.
Am J Ther. 2016 Jul-Aug;23(4):e1004-8. doi: 10.1097/01.mjt.0000434042.62372.49.
It is of clinical importance to determine creatinine clearance and adjust doses of prescribed drugs accordingly in patients with heart failure to prevent untoward effects. There is a scarcity of studies in the literature investigating this issue particularly in patients with heart failure, in whom many have impaired kidney function. The purpose of this study was to determine the degree of awareness of medication prescription as to creatinine clearance in patients hospitalized with heart failure. Patients hospitalized with a diagnosis of heart failure were retrospectively evaluated. Among screened charts, patients with left ventricular ejection fraction <40% and an estimated glomerular filtration rate (eGFR) of ≤50 mL/min were included in the analysis. The medications and respective doses prescribed at discharge were recorded. Medications requiring renal dose adjustment were determined and evaluated for appropriate dosing according to eGFR. A total of 388 patients with concomitant heart failure and renal dysfunction were included in the study. The total number of prescribed medications was 2808 and 48.3% (1357 medications) required renal dose adjustment. Of the 1357 medications, 12.6% (171 medications) were found to be inappropriately prescribed according to eGFR. The most common inappropriately prescribed medications were famotidine, metformin, perindopril, and ramipril. A significant portion of medications used in heart failure requires dose adjustment. Our results showed that in a typical cohort of patients with heart failure, many drugs are prescribed at inappropriately high doses according to creatinine clearance. Awareness should be increased among physicians caring for patients with heart failure to prevent adverse events related to medications.
对于心力衰竭患者，测定肌酐清除率并据此调整处方药剂量以预防不良反应具有临床重要性。文献中缺乏针对这一问题的研究，尤其是在许多肾功能受损的心力衰竭患者中。本研究的目的是确定心力衰竭住院患者对肌酐清除率在药物处方方面的知晓程度。对诊断为心力衰竭的住院患者进行回顾性评估。在筛选的病历中，左心室射血分数<40%且估计肾小球滤过率（eGFR）≤50 mL/分钟的患者纳入分析。记录出院时开具的药物及各自剂量。确定需要肾剂量调整的药物，并根据eGFR评估给药是否合适。本研究共纳入388例合并心力衰竭和肾功能不全的患者。开具的药物总数为2808种，其中48.3%（1357种药物）需要肾剂量调整。在这1357种药物中，12.6%（171种药物）根据eGFR被发现处方不当。最常见的处方不当药物是法莫替丁、二甲双胍、培哚普利和雷米普利。心力衰竭中使用的很大一部分药物需要剂量调整。我们的结果表明，在典型的心力衰竭患者队列中，许多药物根据肌酐清除率的处方剂量过高。应提高照顾心力衰竭患者的医生的认识，以预防与药物相关的不良事件。
