Department of Pharmacy Practice, Dubai Pharmacy College for Girls, Dubai Medical University, Dubai, United Arab Emirates.
Institute of Public Health, College of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
PLoS One. 2024 Sep 19;19(9):e0310081. doi: 10.1371/journal.pone.0310081. eCollection 2024.
Kidney function assessment is crucial in critical illness patients and is required before administering renally excreted medication, especially antibiotics and antiepileptics. Conventional clinical practice often focuses on renal impairment with low creatinine clearance (CrCl) and overlooks the augmented renal clearance (ARC), which is defined by (CrCl) more than 130 ml/min. This typical demonstration neglects individuals who experience hyperfunctioning kidneys. Among critically ill patients, the prevalence of (ARC) is approximately 20% to 65% of cases. This study aims to evaluate physicians' and clinical pharmacists' knowledge about ARC-associated risk factors, antibiotic regimen modification in ARC patients, and attitudes towards ARC workshops and guidelines in Al-Ain, UAE.
A cross-sectional, online self-administered survey-based study was designed to achieve this study's aim. The questionnaire was constructed on profound literature analysis, validated, and piloted. The survey was emailed to physicians and pharmacists working in two hospitals, private and governmental, and distributed through different social media platforms over three months, December 2022-February 2023.
Of the 92 complete responses (32 clinical pharmacists, 60 physicians), 57 (61.9%), were aware of ARC, but 72 (78%) demonstrated poor knowledge overall. Clinical pharmacists had a higher mean rank of knowledge than the physician's group. Meanwhile, 70 (76.1%) participants were unaware of the eGFR threshold to determine ARC. There is a noticeable positive attitude toward seeking more information about antibiotic dose adjustment in ARC patients at 85 (92%) of the respondents. Remarkably, only 28 (30.4%) were directly involved with ARC patients' treatment plans.
In conclusion, clinical pharmacists showed better knowledge than physicians. However, overall, the participating healthcare providers lacked knowledge about ARC, so a reliable source of information regarding ARC should be utilized. Future research could explore the implementation of professional development workshops for healthcare providers and national guidelines and then assess their impact on patient outcomes.
在危重病患者中，肾功能评估至关重要，特别是在给予经肾脏排泄的药物之前，如抗生素和抗癫痫药。传统的临床实践通常侧重于肾功能损害伴低肌酐清除率（CrCl），而忽略了增强的肾清除率（ARC），其定义为 CrCl 超过 130ml/min。这种典型的表现忽略了那些经历肾脏高功能的个体。在危重病患者中，ARC 的患病率约为 20%至 65%。本研究旨在评估阿联酋艾因的医生和临床药师对与 ARC 相关的危险因素、ARC 患者抗生素方案调整以及对 ARC 研讨会和指南的态度的认识。
设计了一项横断面、在线自我管理的基于调查的研究来实现本研究的目的。问卷是在深入的文献分析、验证和试点的基础上构建的。该调查于 2022 年 12 月至 2023 年 2 月通过电子邮件发送给在两家医院（私立和政府）工作的医生和药剂师，并通过不同的社交媒体平台分发了三个月。
在 92 份完整的回复中（32 名临床药师，60 名医生），57 名（61.9%）知道 ARC，但总体而言，72 名（78%）的知识水平较差。临床药师的知识平均排名高于医生组。同时，70 名（76.1%）参与者不知道确定 ARC 的 eGFR 阈值。85 名（92%）的受访者对寻求更多关于 ARC 患者抗生素剂量调整的信息表现出明显的积极态度。值得注意的是，只有 28 名（30.4%）直接参与了 ARC 患者的治疗计划。
总之，临床药师的知识水平优于医生。然而，总的来说，参与的医疗保健提供者缺乏关于 ARC 的知识，因此应该利用可靠的 ARC 信息来源。未来的研究可以探索为医疗保健提供者提供专业发展研讨会和国家指南，并评估它们对患者结局的影响。
