Introduction:
Renal function derangement is a common finding in hospitalized patients. Despite its common occurrence, the renal dose adjustment of medications given to such patients may not be applied adequately. This exacerbates kidney damage irreversibly and, worsens the clinical condition of the patient, creates an extra burden on the health care system.
Methods:
: A prospective study was conducted for 7 months at Saint Paul’s Hospital Millennium Medical College pediatric inpatient services. Data were collected from the HMIS registry and patient charts. Deranged RFT were identified by age specific serum creatinine reference ranges .GFR was calculated using the modified Schwartz formula. Children above 2 years of age were included in the study if the GFR was below 60 and those below 2 years, if the GFR was below their age- appropriate value. Socio-demographic data, RFT and type of medication given were collected from the patient’s chart. Dose appropriateness was determined by comparing practice with the reference to drug dosage in renal impairment patient from the Harriet lane handbook, 21st edition.
Results:
405 prescriptions were made for 27 patients with renal impairment. 23 of the patients had AKI and the remaining were CKD cases. Their age was from 2 weeks to 14 years. Out of these prescriptions, 38.7 %( 157) of them needed dose adjustments. But, only 29.3 %( 46) of these prescriptions were given with dose adjustment and 70.7 %( 111) were given without dose adjustment. The most common type of abnormal prescription was observed in drugs requiring serum levels. Antibiotics were the commonest group of medication requiring dose adjustment and given with inappropriate adjustment. Administration of appropriately adjusted drugs was significantly affected by the stage of AKI, Class of medications (antibiotics, anti-inflammatory, metabolic drugs) and cause of admission.
Conclusions:
medications requiring dose adjustment are being ordered frequently for patients with derangement of renal function. A guideline for the prescription of medications requiring dose adjustment should be prepared and practiced.
I have no potential conflict of interest to disclose.
I used generative AI and AI-assisted technologies in the writing process.