Medication reconciliation for admission of patients with kidney disease

Introduction: Pharmaceutical interventions (PI) aim to solve problems related to drug therapy and are performed by the medical team. Objectives: To quantify, evaluate, and analyze the outcome of PI performed during the admission conciliation of patients with kidney disease in a high-complexity hospital in southern Brazil. Methods: Data were collected in the AGHUse system on PI performed by the clinical pharmacist specialized in nephrology for patients admitted between March/2021 and May/2022, except for kidney transplant patients. The chi-square test in Excel was used to assess adherence to PI by communication mode, considering p<0.05 significant. Results and Conclusions: A total of 618 PI were performed for 152 patients, resulting in an average of 4.1 PI per patient. A discrepancy was observed between home therapy and the inpatient prescription in 61% (93) of patients, resulting in 381 PI for resolution. Home medications were absent from the initial prescription of 90% (84) of patients, with requests for inclusion being the most frequent cause of PI (78.5%, 299). According to the ATC classification, medications for the digestive system and metabolism (group A) accounted for 26.4% (79) of the inclusion PI, followed by medications for the blood and hematopoietic organs (group B) with 25.1% (75), nervous system (group N) with 17.1% (51) and cardiovascular system (group C) with 14.7% (44). PIs for other anatomical groups corresponded to 16.7% (50). The medical team included the requested medication in 55.9% (167) of cases, with 85.3% (255) of contacts made via the electronic system. PIs performed in person had greater adherence (p<0.05). There is a significant risk of omission of home medications during hospitalization. Clinical pharmacist interventions, especially when performed in person, increase the chance of solving these problems in pharmacotherapy. CAAE 02591218.2.0000.5327.