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Drug dosage in patients with renal failure optimized by immediate concurrent feedback

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Abstract

OBJECTIVE: To examine the impact of immediate concurrent feedback on dose adjustment in patients with renal failure.

DESIGN: Prospective 12-month study in patients with various degrees of renal failure, with comparison to a retrospective control group.

SETTING: A 39-bed unit of a university hospital providing primary and tertiary care.

PATIENTS: Patients with renal failure (estimated creatinine clearance ≤50 mL/min) receiving at least 1 pharmacologically active drug.

INTERVENTIONS: Education of physicians and immediate concurrent feedback on the ward giving estimated creatinine clearance and dose recommendations for renally eliminated drugs adjusted to individual renal function.

MEASUREMENTS AND MAIN RESULTS: The percentage of dosage regimens adjusted to renal function and cost assessment of drug therapy were calculated. Overall, 17% of the patients had at least 1 estimated creatinine clearance ≤50 mL/min. In the intervention group, the dose of 81% of renally eliminated drugs was adjusted to renal function, compared with 33% in the control group (P<.001). The mean difference in cost between standard and adjusted dose of renally eliminated drugs in the intervention and control groups was 5.3±12.3 and 0.75±2.8 Swiss francs (approximately US$3.5 and US$0.5), respectively (P<.001), accounting for 16.5% and 2.8%, respectively, of daily medication costs of all drugs.

CONCLUSIONS: The proportion of doses of renally eliminated drugs adjusted to renal function can be substantially increased by immediate concurrent feedback. This saves drug costs and has the potential to prevent adverse drug reactions.

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Authors and Affiliations

  1. Received from the Divisions of Clinical Pharmacology, University Hospital, Basel, Switzerland

    Ariane D. Falconnier PhD

  2. General Internal Medicine, University Hospital, Basel, Switzerland

    Ronald A. Schoenenberger MD, MPH

  3. Department of Internal Medicine, Institute of Hospital Pharmacy, University Hospital, Basel, Switzerland

    Ariane D. Falconnier PhD & Christian Surber PhD

  4. Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, Ruprecht-Karls-University, Bergheimer Str. 58, D-69115, Heidelberg, Germany

    Walter E. Haefeli MD &  Meret Martin-Facklam PhD

Authors
  1. Ariane D. Falconnier PhD
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  2. Walter E. Haefeli MD
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  3. Ronald A. Schoenenberger MD, MPH
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  4. Christian Surber PhD
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  5. Meret Martin-Facklam PhD
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Corresponding author

Correspondence to Meret Martin-Facklam PhD.

Additional information

This study was supported in part by grants from the Senglet Stiftung Basel, the Fonds Golaz of the Schweizerische Apothekerverein Bern-Liebefeld, and the Freiwillige Akademische Gesellschaft Basel; a grant from Mr. and Mrs. Wilhelm V.T. Martius-Fasser; a grant of the Wissenschaftliche Kredit of the University Hospital Basel; and BMBF grant 01EC9902.

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Falconnier, A.D., Haefeli, W.E., Schoenenberger, R.A. et al. Drug dosage in patients with renal failure optimized by immediate concurrent feedback. J GEN INTERN MED 16, 369–375 (2001). https://doi.org/10.1046/j.1525-1497.2001.016006369.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2001.016006369.x

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