Identifying the pattern and risk factors for potential medication dosing errors in chronic renal impairment of critically ill patients

Document Type : Original Article


1 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran.

2 Anesthesiology and Critical Care Research Center, Isfahan, Iran Nosocomial Infection Research Center, Isfahan, Iran Anesthesiology and Critical Care Department, faculty of medicine, Isfahan University of Medical Sciences, Isfahan, Iran



Purpose: Different prescription entries usually complicate the drug therapy for critically ill patients; therefore, we conducted this prospective study to assess the rates for appropriate renal dosing modifications in chronic kidney disease (CKD) patients admitted to the ICU and reported possible related factors of misadjustments.
Design: We enrolled adult ICU patients who received at least one drug and experienced CKD with the estimated glomerular filtration rate (eGFR) ≤ of 59 ml/min on ICU admission. The latest Lexicomp drug information handbook recommendations were also applied as a standard guide for renal dosing changes.
results: A total of 701 prescription entries were studied in 97 patients, and 13.8% (97 medications) required renal dose adjustment. Of the 97 drugs, 20.6% (20) had not been prescribed appropriately, according to eGFR. Antibiotics were the most likely medication group to require a dose adjustment and comprised the largest number of inappropriate prescriptions in our study. EGFR and the number of drugs that needed dose modification significantly affected renal dosing adjustment accuracy (p = 0.03 and 0.01, respectively).
conclusion: These results revealed a high percentage of appropriate renal dose adjustment in ICU compared to other studies that evaluated non-critically ill patients. However, more attention should be paid to patients with a higher number of prescribed medicines for renal dose modification and lower eGFR to reduce medication errors.


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