巴基斯坦慢性肾脏病患者用药剂量错误的模式及预测因素：单中心回顾性分析
Pattern and Predictors of Medication Dosing Errors in Chronic Kidney Disease Patients in Pakistan: A Single Center Retrospective Analysis.
作者信息
Saleem Ahsan, Masood Imran
机构信息
Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan.
出版信息
PLoS One. 2016 Jul 1;11(7):e0158677. doi: 10.1371/journal.pone.0158677. eCollection 2016.
BACKGROUND
Chronic kidney disease (CKD) alters the pharmacokinetic and pharmacodynamic response of various drugs and increases the risk of toxicity. The data regarding the pattern and predictors of medication dosing errors is scare from the developing countries. Therefore, the present study was conducted to assess the pattern and predictors of medication dosing errors in CKD patients in a tertiary care setting in Pakistan.
METHODS
A retrospective study design was employed and medical charts of all those CKD patients who had an eGFR ≤60ml/min/1.73m2, hospitalization ≥24 hours, and admitted in the nephrology unit during January 2013 to December 2014 were assessed. Descriptive statistics and the logistic regression analysis were done using IBM SPSS version 20.
RESULTS
In total, 205 medical charts were assessed. The mean age of patients was 38.64 (±16.82) years. Overall, 1534 drugs were prescribed to CKD patients, of which, nearly 34.0% drugs required dose adjustment. Among those drugs, only 41.8% were properly adjusted, and the remaining 58.2% were unadjusted. The logistic regression analysis revealed that the medication dosing errors were significantly associated with the CKD stages, i.e. stage 4 (OR 0.054; 95% CI [0.017-0.177]; p <0.001) and stage 5 (OR 0.098; 95% CI [0.040-0.241]; p <0.001), the number of prescribed medicines ≥ 5 (OR 0.306; 95% CI [0.133-0.704]; p 0.005), and the presence of a comorbidity (OR 0.455; 95% CI [0.226-0.916]; p 0.027) such as the hypertension (OR 0.453; 95% CI [0.231-0.887]; p 0.021).
CONCLUSIONS
It is concluded that more than half drugs prescribed to CKD patients requiring dose adjustment were unadjusted. The predictors of medication dosing errors were the severe-to-end stages of chronic kidney disease, the presence of a comorbidity such as hypertension, and a higher number of prescribed medicines. Therefore, attention should be paid to these risk factors.
背景
慢性肾脏病（CKD）会改变多种药物的药代动力学和药效学反应，并增加毒性风险。来自发展中国家的关于用药剂量错误模式及预测因素的数据匮乏。因此，本研究旨在评估巴基斯坦一家三级医疗机构中CKD患者用药剂量错误的模式及预测因素。
方法
采用回顾性研究设计，对2013年1月至2014年12月期间所有估算肾小球滤过率（eGFR）≤60ml/（min·1.73m²）、住院时间≥24小时且入住肾病科的CKD患者的病历进行评估。使用IBM SPSS 20版进行描述性统计和逻辑回归分析。
结果
共评估了205份病历。患者的平均年龄为38.64（±16.82）岁。总体而言，共为CKD患者开具了1534种药物，其中近34.0%的药物需要调整剂量。在这些药物中，只有41.8%得到了适当调整，其余58.2%未调整。逻辑回归分析显示，用药剂量错误与CKD分期显著相关，即4期（比值比[OR]0.054；95%置信区间[CI][0.017 - 0.177]；p<0.001）和5期（OR 0.098；95% CI[0.040 - 0.241]；p<0.001），开具药物数量≥5种（OR 0.306；95% CI[0.133 - 0.704]；p 0.005），以及存在合并症（OR 0.455；95% CI[0.226 - 0.916]；p 0.027），如高血压（OR 0.453；95% CI[0.231 - 0.887]；p 0.021）。
结论
得出的结论是，为需要调整剂量的CKD患者开具的药物中，超过一半未进行调整。用药剂量错误的预测因素是慢性肾脏病的重度至终末期、存在如高血压等合并症以及开具药物数量较多。因此，应关注这些危险因素。
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