Loiodice Jessica M, Fogel Joshua, Rubinstein Sofia
Department of Internal Medicine, New York University Langone Hospital-Long Island, Mineola, New York, USA.
Division of Nephrology and Hypertension, Nassau University Medical Center, East Meadow, New York, USA.
Proc (Bayl Univ Med Cent). 2023 Jul 18;36(5):627-634. doi: 10.1080/08998280.2023.2228172. eCollection 2023.
Patients with chronic kidney disease (CKD) are at increased risk for adverse drug events due to medication dosing errors. We studied the awareness and knowledge among internal medicine housestaff (IMHS) of proper dose adjustment of commonly used rheumatology and allergy/immunology medications for patients with CKD.
We surveyed 353 IMHS to evaluate their awareness of the need for medication dose adjustments for patients with CKD and knowledge for medication adjustment by level of glomerular filtration rate for common rheumatology and allergy/immunology medications.
There was lack of awareness and knowledge for both rheumatology and allergy/immunology medications. Incorrect awareness and knowledge were as follows: allopurinol, 21.2%, 73.4%; colchicine, 19.0%, 75.9%; diphenhydramine, 34.0%, 34.0%; loratadine, 82.2%, 93.2%; and montelukast, 34.0%, 34.0%, respectively. Exploratory logistic regression analyses showed that PGY1 residents had higher odds for lack of awareness for allopurinol (odds ratio [OR] 24.57, 95% CI [confidence interval] 4.69, 99.13, < 0.001), colchicine (OR 3.98, 95% CI 1.50, 10.51, < 0.01), diphenhydramine (OR 2.24, 95% CI 1.10, 4.54, < 0.04), and montelukast (OR 2.45, 95% CI 1.20, 5.00, < 0.05) than PGY3 residents. A nephrology rotation in medical school was associated with lower odds for incorrect knowledge for allopurinol (OR 0.46, 95% CI 0.25, 0.87, < 0.05) and montelukast (OR 0.50, 95% CI 0.27, 0.92, < 0.05).
Overall, awareness and knowledge were poor among IMHS for dose adjustments of rheumatology and allergy/immunology medications in patients with CKD. Proper education and exposure to nephrology during training may improve quality and safety of care for patients with CKD.
慢性肾脏病（CKD）患者因用药剂量错误而发生药物不良事件的风险增加。我们研究了内科住院医师（IMHS）对CKD患者常用风湿科及过敏/免疫科药物适当剂量调整的认识和知识。
我们对353名IMHS进行了调查，以评估他们对CKD患者药物剂量调整必要性的认识，以及对常见风湿科和过敏/免疫科药物根据肾小球滤过率水平进行药物调整的知识。
对于风湿科和过敏/免疫科药物，均存在认识不足和知识欠缺的情况。认识错误和知识错误的比例分别如下：别嘌醇为21.2%、73.4%；秋水仙碱为19.0%、75.9%；苯海拉明为34.0%、34.0%；氯雷他定为82.2%、93.2%；孟鲁司特为34.0%、34.0%。探索性逻辑回归分析显示，与PGY3住院医师相比，PGY1住院医师对别嘌醇认识不足的几率更高（优势比[OR] 24.57，95%置信区间[CI] 4.69，99.13，P < 0.001）、对秋水仙碱认识不足的几率更高（OR 3.98，95% CI 1.50，10.51，P < 0.01）、对苯海拉明认识不足的几率更高（OR 2.24，95% CI 1.10，4.54，P < 0.04）、对孟鲁司特认识不足的几率更高（OR 2.45，95% CI 1.20，5.00，P < 0.05）。医学院的肾脏病轮转与别嘌醇知识错误几率较低相关（OR 0.46，95% CI 0.25，0.87，P < 0.05）以及与孟鲁司特知识错误几率较低相关（OR 0.50，95% CI 0.27，0.92，P < 0.05）。
总体而言，IMHS对CKD患者风湿科和过敏/免疫科药物剂量调整的认识和知识较差。培训期间进行适当的教育并接触肾脏病学可能会提高CKD患者的护理质量和安全性。
