המידע באדיבות מדיקונטקסט
Last Updated: 2001-07-13 15:07:37 EDT (Reuters Health)
By Megan Rauscher
WESTPORT, CT (Reuters Health) – Having a pharmacist participate in clinical rounds can substantially reduce inappropriate drug dosing in patients with renal failure, a German team reports in the June issue of the Journal of General Internal Medicine.
Impairment of renal function is not always appropriately considered when drugs are prescribed to hospitalized patients, Dr. Meret Martin-Facklam, of University Hospital, Heidelberg, and colleagues have found.
The fact that serum creatinine concentrations, particularly in elderly patients, are often apparently normal despite substantial renal impairment coupled with the fact that renally eliminated drugs are not actively known by physicians, contribute to the problem, Dr. Martin-Facklam said in comments to Reuters Health.
In a 12-month prospective study, the researchers discovered that they could optimize drug dosing in renal failure patients by having pharmacists on hand to estimate creatinine clearance and provide dose recommendations for renally eliminated drugs adjusted to individual renal function.
Study subjects included 806 patients with varying degrees of renal failure and 842 retrospective controls. The researchers report that in the pharmacist-directed "immediate concurrent feedback" intervention group 81% of renally eliminated drugs were adjusted to renal function, compared with 33% in the control group. "This saves drug costs and has the potential to prevent adverse drug reactions," the researchers note in the paper.
Dr. Martin-Facklam's team is currently working on developing an electronic expert system to assist drug dosing in renal failure patients, which is open to review at http:www.dosing.de.
In the meantime, the researcher said that a concurrent-feedback protocol can be instituted immediately. "All that is needed is a list of the Qo-values (the fraction of the bioavailable dose which is eliminated extrarenally) and an algorithm for estimation of renal function based on weight, age, and serum creatinine. Both can easily be determined with a pocket calculator," he continued.
Dr. Martin-Facklam said that a pocket-size list of the most important drugs and their Qo-values will be made available in German and English by the end of September. The list can be obtained through the Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University Hospital, Heidelberg, Germany.
J Gen Intern Med 2001;16:369-375.
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