黎巴嫩两家大学医院慢性肾病患者肾药物剂量调整的评估。
Evaluation of renal drug dosing adjustment in chronic kidney disease patients at two university hospitals in Lebanon.
作者信息
Saad Rayane, Hallit Souheil, Chahine Bahia
机构信息
School of Pharmacy, Lebanese International University. Beirut, (Lebanon).
INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie; Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh (Lebanon).
出版信息
Pharm Pract (Granada). 2019 Jan-Mar;17(1):1304. doi: 10.18549/PharmPract.2019.1.1304. Epub 2019 Feb 27.
BACKGROUND
Inappropriate medication dosing in patients with chronic kidney disease can cause toxicity or ineffective therapy. Patients are at a high risk of developing related adverse events caused by the altered effect of drugs in conjunction with the use of polypharmacy to treat comorbid conditions. This necessitates adequate renal dosing adjustments.
OBJECTIVE
The current study aims at assessing whether appropriate dosing adjustments were made in hospitalized patients with chronic kidney disease.
METHODS
A retrospective descriptive study was conducted at two university hospitals in Beirut between January and December 2016. All adult CKD patients with creatinine clearance less than 60 ml/min and receiving at least one medication that require renal dosing adjustment were included. Kidney function was estimated from serum creatinine using Cockcroft-Gault equation, and dose appropriateness was determined by comparing practice with specific guidelines. The rates of renal drug dosing adjustment were investigated, in addition to the influence of possible determinants, such as the severity of renal impairment, reason of hospital admission, and other patient characteristics.
RESULTS
2138 patients admitted in 2016 were screened. 223 adults receiving 578 drug orders that require adjustment were included. Among the 578 orders, 215 (37%) were adjusted adequately, 284 (49%) were adjusted inadequately, and 79 (14%) were not adjusted at all. Beta-blockers were the most inadequately dosed (83.6%) class of medication, whereas lipid-lowering agents had the highest percentage of adequate dosing (65.1%). As per patient, 84.3% of patients appeared to be receiving at least one inappropriate drug dose.
CONCLUSIONS
Our study confirms that physicians are not prescribing appropriate dosing adjustments in chronic kidney disease inpatients, which may have deleterious effects. This highlights the need for more nephrology consultation and the implementation of physician education programs.
背景
慢性肾脏病患者用药剂量不当可导致毒性反应或治疗无效。由于药物作用改变以及联合使用多种药物治疗合并症，患者发生相关不良事件的风险很高。这就需要进行适当的肾脏剂量调整。
目的
本研究旨在评估住院慢性肾脏病患者是否进行了适当的剂量调整。
方法
2016年1月至12月在贝鲁特的两家大学医院进行了一项回顾性描述性研究。纳入所有肌酐清除率低于60 ml/min且接受至少一种需要进行肾脏剂量调整药物治疗的成年慢性肾脏病患者。使用Cockcroft-Gault方程根据血清肌酐估算肾功能，并通过将实际做法与特定指南进行比较来确定剂量是否合适。除了可能的决定因素（如肾功能损害的严重程度、入院原因和其他患者特征）的影响外，还调查了肾脏药物剂量调整的发生率。
结果
对2016年入院的2138例患者进行了筛查。纳入了223例接受578项需要调整药物医嘱的成年人。在这578项医嘱中，215项（37%）调整适当，284项（49%）调整不充分，79项（14%）根本未调整。β受体阻滞剂是剂量调整最不充分的药物类别（83.6%），而降脂药物的适当剂量百分比最高（65.1%）。就患者而言，84.3%的患者似乎至少接受了一种不适当的药物剂量。
结论
我们研究证实，医生未对慢性肾脏病住院患者进行适当的剂量调整，这可能会产生有害影响。这突出表明需要更多的肾脏病会诊以及实施医生教育项目。
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