Amkreutz Julia, Koch Alexander, Buendgens Lukas, Muehlfeld Anja, Trautwein Christian, Eisert Albrecht
Hospital Pharmacy, University Hospital RWTH Aachen, Aachen, Germany.
Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany.
Int J Clin Pharm. 2017 Oct;39(5):1128-1139. doi: 10.1007/s11096-017-0525-4. Epub 2017 Aug 19.
Background Complex polypharmacotherapy makes kidney transplant patients vulnerable to drug-drug interactions (DDIs). Objective To study prevalence and nature of potential DDIs (pDDIs) in kidney transplant patients. Setting Internal medicine ICU, University Hospital RWTH Aachen. Method In this retrospective observational study, pDDIs were identified in the first week after transplant from 1999 to 2010. Patients aged at least 18 years with prescription of at least two drugs were included. Patients with incomplete data were excluded. Data was originally obtained from medical charts. Two Clinical Decision Support Systems (CDSSs) in German language, mediQ and Meona, were used for pDDI identification and severity rating. Main outcome measure PDDIs in each severity level of the CDSSs/100 patient days. Results A total of 252 patients with 37,577 prescriptions were analysed. We found 99 pDDIs from severity levels major/contraindicated in Meona and 299 pDDIs from severity levels clinically relevant/strong in mediQ per 100 patient days. Most important potential consequences of pDDIs in respective severity levels were changes in immunosuppressant drug and potassium levels, nephrotoxicity and cardiac adverse events. Conclusion This study found a high prevalence of pDDIs in the first week after kidney transplant. Medication should be checked for pDDIs to prevent ADEs. It is strongly advisable to closely monitor patients within the first week after transplant for clinical and laboratory parameters and if necessary, change therapy. Physician education on the basis of study findings, DDI check with Clinical Physician Order Entry System/CDSSs and integration of a clinical pharmacist into the ward team should be targeted.
背景 复杂的多药联合治疗使肾移植患者容易发生药物相互作用（DDIs）。目的 研究肾移植患者中潜在药物相互作用（pDDIs）的发生率及性质。地点 亚琛工业大学医院内科重症监护病房。方法 在这项回顾性观察研究中，于1999年至2010年肾移植后的第一周识别pDDIs。纳入年龄至少18岁且开具至少两种药物处方的患者。排除数据不完整的患者。数据最初来自病历。使用两个德语临床决策支持系统（CDSSs），即mediQ和Meona，进行pDDI识别和严重程度分级。主要结局指标 CDSSs各严重程度级别的每100患者日的pDDIs。结果 共分析了252例患者的37577张处方。我们发现，Meona中主要/禁忌严重程度级别的每100患者日有99例pDDIs，mediQ中临床相关/强烈严重程度级别的每100患者日有299例pDDIs。pDDIs在各自严重程度级别中最重要的潜在后果是免疫抑制药物和钾水平的变化、肾毒性和心脏不良事件。结论 本研究发现肾移植后第一周pDDIs的发生率很高。应检查药物是否存在pDDIs以预防药物不良反应（ADEs）。强烈建议在移植后的第一周密切监测患者的临床和实验室参数，必要时更改治疗方案。应基于研究结果对医生进行教育，使用临床医生医嘱录入系统/CDSSs进行DDI检查，并将临床药师纳入病房团队。
