Abstract
Individuals with chronic kidney disease (CKD) use polypharmacy, which, in combination with renal impairment, exposes them to the risk of drug-related problems (DRPs). There are no available tools in Brazil to systematically assess the pharmacotherapy and management of DRPs in this population. Therefore, the objective of this work was to validate the PAIR instrument (Pharmacotherapy Assessment in Chronic Renal Disease) for use in Brazilian Portuguese. This is a retrospective longitudinal observational study. Medical records from 100 CKD patients under conservative treatment, between 2016 and 2017, in a nephrology clinic, were analyzed. PAIR was applied by pharmacists in two consultations of the same patient, with an interval of 6 months. Reliability, conceptual validity, responsiveness of the instrument and prevalence of DRPs in the studied sample were assessed. A mean of 1.26 ± 0.96 DRPs/patient was identified. Inter-rater reliability coefficients (k) ranged from 0.58 to 0.94 and from 0.79 to 1.00 for test-retest, revealing moderate to perfect level of agreement. In conceptual validity, a mean of 1.60 ± 1.24 DRPs/patient was identified by the nephrologist through clinical judgment, compared to 1.33±0.76 DRPs/patient identified by the pharmacist using PAIR (p = 0.07). Therefore PAIR allowed the identification of clinically significant DRPs. In responsiveness, a mean of 1.26 ± 0.96 DRPs/patient was identified at the first consultation and 1.11 ± 1.02 DRPs/patient at the subsequent consultation (p = 0.17) by the pharmacist using PAIR. The number of DRPs between the periods did not change. As a conclusion, the PAIR allowed the identification of clinically significant DRPs in CKD, constituting a new validated instrument to be used in Brazil.
Highlights
Chronic kidney disease (CKD) is a global public health problem, which has a negative impact on the expectation and quality of life of individuals with the disease.[1,2] In Brazil, about 133 thousand people undergo renal replacement therapy (RRT), more than twice as much as there was at the beginning of the last century.[3]
We studied the following sociodemographic, clinical and laboratory variables: ethnics, gender, age, smoking, drinking, schooling, weight, height, body mass index (BMI) according to the BMI formula = weight/height[2], etiology and CKD stage, comorbidities, class and total number of drugs in use, serum creatinine to estimate the glomerular filtration rate, according to the formula of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI).[24]
Among the 100 patients who were eligible for the study, there was a predominance of female individuals (55%), elderly (71%), with an average age of 67 years, with a low level of education incomplete primary education - (73%), in stages 3b (38%) and 4 (32%) of CKD, with overweight and obesity (77%), with an average BMI of 30.4 ± 6.1
Summary
Chronic kidney disease (CKD) is a global public health problem, which has a negative impact on the expectation and quality of life of individuals with the disease.[1,2] In Brazil, about 133 thousand people undergo renal replacement therapy (RRT), more than twice as much as there was at the beginning of the last century.[3]. Among the main risk factors for CKD are diabetes mellitus (DM) and systemic arterial hypertension (SAH), responsible for two thirds of the cases of the disease. This population, made up predominantly of elderly people, has several comorbidities, the approach of which involves the continuous use of multiple medications.[1,4,5] data from our outpatient care service for patients with CKD showed the use of polypharmacy by 66, 5% of patients undergoing conservative treatment, on average six drugs per patient, mainly drugs acting on the cardiovascular and metabolic systems.[6]
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