Pharmacists at a Danish hospital have developed an evidence-based quick guide for assessing renal risk medications in patients with impaired renal function who are at higher risk of suboptimal and potentially harmful medication treatment due to changes in pharmacokinetics and pharmacodynamics.
Through the quick guide’s recommendations, the researchers hope to optimise treatment; minimise adverse reactions and toxicity; and reduce morbidity, hospitalisation and mortality in these patients.
Firstly, the researchers determined the 100 most commonly used medications in hospitals and in primary care using the Danish National Business Intelligence tool and Danish National Prescription Registry, respectively.
Then, after combining the 200 records, 29 duplicates were excluded, and 171 were reviewed by two clinical pharmacists against three criteria. To be included, each of these medications had to have dose adjustments or indicated contraindications for patients with impaired kidney function listed on the Renal Drug Database or the national drug monography Pro.medicin.dk, and at least 30% of the active ingredient or active metabolites be renally excreted.
The pharmacists excluded 121 medications, resulting in a final count of 50 to be included in the quick guide. Each entry lists recommendations for prescribing adjustments due to impaired renal function. The most prevalent medications on the list are from the Anatomical Therapeutic Chemical Classification System (ATC)-group N, C and L.
It is the first evidence-based renal risk medication quick guide for hospital pharmacists. It offers a practical tool to help healthcare professionals manage renal risk medications effectively, avoid inappropriate dosing and improve patient safety for those with impaired renal function.
The guide does not, however, encompass all renal risk medications, only focusing on medications frequently used in the hospital setting. The researchers also noted that the quick guide currently only provides a snapshot and for optimal use would require frequent updates and peer-review.
The researchers plan to evaluate the feasibility of using the quick guide in routine medication reviews in the next steps of their research.
Longer term, implementing the quick guide as an electronic decision tool in the electronic patient journal systems in Denmark to improve guidance to hospital physicians and in primary care may be of use, they added.
Reference
Ravn-Nielsen, L et al. Development of a quick guide for assessment of the most frequently used renal risk medication in Danish hospitals and primary care. Basic Clin Pharmacol Toxicol. 2024; Aug 20: DOI: 10.1111/bcpt.14068.
