Audit and re-audit of medication use in patients with impaired kidney function
Medications prescribed for patients with chronic kidney disease (CKD) often require dose adjustments to ensure safety and efficacy. An audit was undertaken in primary care to assess how appropriate current medication use is in this patient cohort.
To identify medications most likely to be prescribed at inappropriate doses in patients with CKD 3-5.
Level 2 medication reviews were carried out by a clinical pharmacist for patients with a diagnosis of CKD level 3-5. The reviews focused on how appropriate medication use/dosages were where dose reduction or discontinuation would be recommended for patients with poor renal function. The audit was repeated a year later.
Drugs that required creatinine clearance (CrCl) to be calculated had the most interventions: eight patients had dose changes implemented for rivaroxaban.
The use of the correct calculation and regular review to assess the use and dose of medications in patients with poor renal function is vital in improving health outcomes.
Patients prescribed medications on a repeat basis need regular review and monitoring. Prescribing medications at usual doses for patients with impaired kidney function can have a negative impact on a patients' health outcomes by increasing the burden placed on the kidney and can affect medication efficacy (British National Formulary [BNF], 2022a). For certain medications, it is vital to monitor kidney function to ensure the correct dose is prescribed, and the medication is still appropriate for use.
In a GP practice, the clinical pharmacist noted that whilst completing medication reviews, some medications prescribed (particularly for those with declining renal function) were often not prescribed at the most appropriate dose for their kidney function.
A drug safety alert form was also released (Electronic Medicines Compendium, 2019), highlighting the importance of using the appropriate estimation of renal function to avoid the risk of adverse drug reactions when prescribing. Medication dosage should be calculated using the most appropriate method, either estimated glomerular filtration rate (eGFR) or creatinine clearance (CrCl), calculated via the Cockcroft-Gault formula (BNF, 2022b).
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