腎機能低下患者における入院時持参薬の使用実態と適正使用への取り組み

Abstract

Pharmacists interview patients soon after their admission to Ehime University Hospital and check any drugs brought to hospital.As physicians often over-prescribe renally eliminated drugs for patients with renal dysfunction,we conducted a usage survey of drugs brought by patients with renal dysfunction.The subjects were 430 persons taking renally eliminated drugs for renal dysfunction admitted during April,2008,and they were classified by stage of chronic kidney disease (CKD) based on their estimated glomerular filtration rate using the simple Modification of Diet in Renal Disease (MDRD) formula.Patients and dosages were retrospectively investigated.There were 102 patients with CKD stage 3 to 5 (23.7%) and many of them were taking such renally eliminated drugs as allopurinol (17 patients) and histamine-2 receptor antagonists (13 patients).In 4 of the patients (23.5%) taking allopurinol and 4 of the patients (30.8%) taking histamine-2 receptor antagonists,the drug had been over-prescribed in consideration of their renal function.In view of our findings,we attached an Excel® spreadsheet incorporating a table of optimal dosages for renally eliminated drugs and formulas for estimating renal function to their patient medical charts.The use of this tool has resulted in an increase in the number of“pre-avoid reports”regarding renally eliminated drugs and we therefore feel that an intervention of this type by pharmacists based on evaluation of renal function will improve pharmaceutical care for CKD patients.