慢性肾脏病患者抗糖尿病药物的剂量调整

Dose adjustment of antidiabetic medications in chronic kidney disease.

作者信息

Snyder Matthew Salvatore, Fogel Joshua, Pyatigorskaya Svetlana, Rubinstein Sofia

机构信息

New York Institute of Technology College of Osteopathic Medicine, 101 Northern Boulevard, Old Westbury, NY, USA.

Department of Business Management, Brooklyn College, 218 Whitehead Hall, Brooklyn, NY, USA.

出版信息

Avicenna J Med. 2021 Jan 5;11(1):33-39. doi: 10.4103/ajm.ajm_110_20. eCollection 2021 Jan-Mar.

DOI:10.4103/ajm.ajm_110_20

PMID:33520787

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7839266/

Abstract

PURPOSE

The purpose of this study is to identify whether Internal Medicine house-staff (IMHS) have awareness and knowledge about the correct dosage of antidiabetic medications for patients with chronic kidney disease (CKD), as dosing errors result in adverse patient outcomes for those with diabetes mellitus (DM) and CKD.

METHODS

There were 353 IMHS surveyed to evaluate incorrect level of awareness of medication dose adjustment in patients with CKD (ILA) and incorrect level of knowledge of glomerular filtration rate level for medication adjustment (ILK-GFR) for Glipizide, Pioglitazone, and Sitagliptin.

RESULTS

Lack of awareness and knowledge was high, with the highest for Pioglitazone at 72.8%. For ILA, the percentages were: Pioglitazone: 72.8%, Glipizide: 43.9%, and Sitagliptin: 42.8%. For ILK-GFR, the percentages were: Pioglitazone: 72.8%, Glipizide: 68.3%, and Sitagliptin: 65.4%.

CONCLUSIONS

IMHS have poor awareness and knowledge for antidiabetic medication dose adjustment in patients with DM and CKD. Both Electronic Medical Rerecord best practice advisory and physician-pharmacist collaborative drug therapy management can enhance safe drug prescribing in patients with CKD. In addition, IMHS's practice for antidiabetic medication dose adjustment was better with Nephrology exposure. A formal didactic educational training during medical school and residency for antidiabetic medication dose adjustment in patients with DM and CKD is highly encouraged to prevent medication dosing errors and to more effectively and safely allow IMHS to manage complex treatment regimens.

摘要

目的

本研究旨在确定内科住院医师（IMHS）是否了解慢性肾脏病（CKD）患者正确的抗糖尿病药物剂量，因为剂量错误会给糖尿病（DM）和CKD患者带来不良预后。

方法

对353名IMHS进行调查，以评估他们对CKD患者药物剂量调整的认识不足水平（ILA）以及对格列吡嗪、吡格列酮和西他列汀药物调整的肾小球滤过率水平的知识不足水平（ILK-GFR）。

结果

认识和知识缺乏程度较高，吡格列酮最高，为72.8%。对于ILA，百分比分别为：吡格列酮72.8%、格列吡嗪43.9%、西他列汀42.8%。对于ILK-GFR，百分比分别为：吡格列酮72.8%、格列吡嗪68.3%、西他列汀65.4%。

结论

IMHS对DM和CKD患者抗糖尿病药物剂量调整的认识和知识较差。电子病历最佳实践建议和医师-药师联合药物治疗管理均可提高CKD患者的安全用药水平。此外，有肾脏病学接触经历的IMHS在抗糖尿病药物剂量调整方面的实践表现更好。强烈建议在医学院校和住院医师培训期间进行正式的关于DM和CKD患者抗糖尿病药物剂量调整的教学培训，以防止用药剂量错误，并使IMHS更有效、安全地管理复杂的治疗方案。