Resumen de Use of nephrotoxic drugs in chronic kidney disease patients
Aurelio Cabello Muriel, Elena Urbieta Sanz, Carles Iniesta Navalón, Juan José Gascón Cánovas
Background: Proper dosing of nephrotoxic drugs in patients with chronic kidney disease (CKD) is essential to prevent damage to cause the disease progresses.
Objective: To determine the prevalence of prescription of nephrotoxic drugs to patients with CKD admitted to an Internal Medicine Department, to assess if they are adjusted to renal function of patients and factors associated with a potential un adjusted dose.
Method: Prospective observational study conducted in a 330-bed hospital. For each patient with CKD admitted, the pharmacotherapeutic history was reviewed, the creatinine clearance (ClCr) was calculated, the nephrotoxic drugs in use were identified, and the dosages of these drugs were assessed. The Chi-square test and Student’s t-test were used for statistical analysis, and a multivariate logistic regression model was used to identify the factors that explain the absence of dose adjustment. The study period was from November 2011 to May 2012.
Results: 287 patients were included. The 52.6% were women, and the mean age was 81.5 ±7.9 years. Of the 3,769 drugs prescribed, 14.7% were potentially nephrotoxic. Of these, 27% were not adjusted according to renal function, and this affected 51% of the patients. The main nephrotoxic drugs with unadjusted dosage were: beta-lactam antibiotics, fluoroquinolones, ACE inhibitors, allopurinol and ranitidine. Statistically significant associations were found between polypharmacy, fluoroquinolones or ranitidine administration, and lack of dose adjustment.
Conclusion: The lack of dose adjustment in more than half of patients admitted with some nephrotoxic drugs suggests the need to implement improvement measures focused on patients with polypharmacy and the mostly affected drugs
