Correct use of non-indexed eGFR for drug dosing and renal drug-related problems at hospital admission
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PHARMACOEPIDEMIOLOGY AND PRESCRIPTION
Correct use of non-indexed eGFR for drug dosing and renal drug-related problems at hospital admission Sarah Seiberth 1,2 & Dominik Bauer 2 & Ulf Schönermarck 3 & Hanna Mannell 2 & Christian Stief 4 & Joerg Hasford 5 & Dorothea Strobach 1,2 Received: 15 November 2019 / Accepted: 1 July 2020 # The Author(s) 2020
Abstract Purpose Two to seven percent of the German adult population has a renal impairment (RI) with an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2. This often remains unrecognized and adjustment of drug therapy is lacking. To determine renal function in clinical routine, the CKD-EPI equation is used to calculate an indexed eGFR (ml/min/1.73m2). For drug dosing, it has to be individualized to a non-indexed eGFR (ml/min) by the patient’s body surface area. Here, we investigated the number of patients admitted to urological wards of a teaching hospital with RI between July and December 2016. Additionally, we correctly used the eGFRnon-indexed for drug and dosage adjustments and to analyse the use of renal risk drugs (RRD) and renal drug-related problems (rDRP). Methods In a retrospective observational study, urological patients with pharmacist-led medication reconciliation at hospital admission and eGFRindexed (CKD-EPI) of 15–59 ml/min/1.73m2 were identified. Indexed eGFR (ml/min/1.73m2) was recalculated with body surface area to non-indexed eGFR (ml/min) for correct drug dosing. Medication at admission was reviewed for RRD and based on the eGFRnon-indexed for rDRP, e.g. inappropriate dose or contraindication. Results Of 1320 screened patients, 270 (20.5%) presented with an eGFRindexed of 15–59 ml/min/1.73m2. After readjustment, 203 (15.4%) patients had an eGFRnon-indexed of 15–59 ml/min. Of these, 190 (93.6%) used ≥ 1 drugs at admission with 660 of 1209 (54.7%) drugs classified as RRD. At least one rDRP was identified in 115 (60.5%) patients concerning 264 (21.8%) drugs. Conclusion Renal impairment is a common risk factor for medication safety in urologic patients admitted to a hospital. Considerable shifts were seen in eGFR-categories when correctly calculating eGFRnon-indexed for drug dosing purposes. The fact that more than half of the study patients showed rDRP at hospital admission underlines the need to consider this risk factor appropriately. Keywords Renal impairment . Renal risk drugs . Renal drug-related problems . Non-indexed estimated glomerular filtration rate (eGFR) Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00228-020-02953-6) contains supplementary material, which is available to authorized users. * Sarah Seiberth [email protected] Dominik Bauer [email protected] Ulf Schönermarck [email protected]
Dorothea Strobach [email protected] 1
Hospital Pharmacy, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
2
Doctoral Program Clinical Pharmacy, University Hospital, LMU Munich, Marchioninistr. 15, 81377
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