[Drugs adjustment dosage at hospital discharge for patients with renal failure: study of 326 medical records]

Abstract

Introduction: The objective of our study was to identify the misuse of drugs necessitating an adaptation to renal function and/or contra-indicated in case of renal failure at discharge.

Design: We conducted a 2-month retrospective study in a French teaching hospital for all patients with at least a moderate renal impairment (eDFG<60 mL/min/1.73 m(2)) discharge from eight units (medical and surgical) and compared their prescriptions to guidelines. We classified each drug prescription as N: drug that do not need adaptation or non contra-indicated for the renal status of patient; A: drug that need an adaptation to kidney but those was correctly done; I: drug that need an adaptation to kidney, those incorrectly done; C: drug contra-indicated in case of renal failure; D: drug for which it is impossible to conclude without an expertise of the patient file.

Results: For patient with eDFG less than 60 mL/min/1.73 m(2), 326 prescriptions corresponding to 2137 drugs were analysed. Misuses concerned 19.0% of patients (n=69). For patient with eDFG less than 30 mL/min/1.73 m(2), 42 prescriptions corresponding to 291 drugs were analysed. Misuses concerned 57.1% of patients (n=24).

Discussion/conclusion: The misuse observed at patient's discharge may have consequences in further prescriptions; discharge prescriptions are often considered as "validated" by general practitioners. Improving solution should be offered to prescribers and as well as to pharmacists to manage drug dosage adaptation to renal function.