Key result
Using non-indexed eGFR for drug dosing reduces renal impairment classifications by ~25%.
Why the study?
Renal impairment often remains unrecognized and drug therapy adjustment is lacking due to incorrect use of indexed eGFR for drug dosing in clinical routine.
Does recalculating indexed eGFR to non-indexed eGFR identify renal drug-related problems in urological patients at hospital admission?
Observational (n=1,320)
No
Does recalculating indexed eGFR to non-indexed eGFR identify renal drug-related problems in urological patients at hospital admission?
Absolute Event Rate: 15.4% vs 20.5%
Recalculating indexed eGFR to non-indexed eGFR reveals a high prevalence of renal drug-related problems in hospitalized urological patients, highlighting the need for individualized drug dosing.
Recalculation of indexed eGFR may reveal renal dosing issues in urological inpatients; leaves open whether routine use improves outcomes.
Purpose Two to seven percent of the German adult population has a renal impairment (RI) with an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2. This often remains unrecognized and adjustment of drug therapy is lacking. To determine renal function in clinical routine, the CKD-EPI equation is used to calculate an indexed eGFR (ml/min/1.73m2). For drug dosing, it has to be individualized to a non-indexed eGFR (ml/min) by the patient’s body surface area. Here, we investigated the number of patients admitted to urological wards of a teaching hospital with RI between July and December 2016. Additionally, we correctly used the eGFRnon-indexedfor drug and dosage adjustments and to analyse the use of renal risk drugs (RRD) and renal drug-related problems (rDRP). Methods In a retrospective observational study, urological patients with pharmacist-led medication reconciliation at hospital admission and eGFRindexed(CKD-EPI) of 15–59 ml/min/1.73m2were identified. Indexed eGFR (ml/min/1.73m2) was recalculated with body surface area to non-indexed eGFR (ml/min) for correct drug dosing. Medication at admission was reviewed for RRD and based on the eGFRnon-indexedfor rDRP, e.g. inappropriate dose or contraindication. Results Of 1320 screened patients, 270 (20.5%) presented with an eGFRindexedof 15–59 ml/min/1.73m2. After readjustment, 203 (15.4%) patients had an eGFRnon-indexedof 15–59 ml/min. Of these, 190 (93.6%) used ≥ 1 drugs at admission with 660 of 1209 (54.7%) drugs classified as RRD. At least one rDRP was identified in 115 (60.5%) patients concerning 264 (21.8%) drugs. Conclusion Renal impairment is a common risk factor for medication safety in urologic patients admitted to a hospital. Considerable shifts were seen in eGFR-categories when correctly calculating eGFRnon-indexedfor drug dosing purposes. The fact that more than half of the study patients showed rDRP at hospital admission underlines the need to consider this risk factor appropriately.
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Seiberth et al. (2020) conducted an observational in Renal impairment (n=1,320). Non-indexed eGFR calculation vs. Indexed eGFR calculation was evaluated on Proportion of patients classified with eGFR 15-59 ml/min. Correctly calculating non-indexed eGFR for drug dosing reduced the proportion of urological patients classified with renal impairment (15-59 ml/min) from 20.5% to 15.4%, of whom 60.5% had at least one renal drug-related problem.
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