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MEDICATION SAFETY

Compliance with Dosing Guidelines in Patients with Chronic Kidney Disease

Pharmacoeconomics and Outcomes Research Fellow, Kaiser Permanente of Colorado, PO Box 378066, Denver, CO 80237-8066, fax 303/636-3149, charron.l.long{at}kp.org

Marsha A Raebel, PharmD BCPS

Pharmacotherapy Research Manager, Kaiser Permanente of Colorado; Adjoint Associate Professor, School of Pharmacy, University of Colorado, Denver

David W Price, MD FAAFP

Director of Education, Kaiser Permanente of Colorado; Associate Professor, Departments of Family Medicine and Psychiatry, School of Medicine, University of Colorado

David J Magid, MD MPH

Assistant Director of Research, Kaiser Permanente of Colorado; Associate Professor, Departments of Emergency Medicine and Preventive Medicine & Biometrics, School of Medicine, University of Colorado

Reprints: not available from author

OBJECTIVE: To assess the level of reported compliance with renal dosing guidelines in inpatient, long-term care, and ambulatory settings.

DATA SOURCES: Available databases (MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, ACP Journal Club) were searched (1966–December 2002) to identify published literature pertaining to renal dosing guideline compliance in patients with chronic kidney disease.

STUDY SELECTION AND DATA EXTRACTION: All articles addressing renal dosing guideline compliance in inpatient, long-term care or ambulatory settings were included. Six articles matching our inclusion criteria were reviewed.

DATA SYNTHESIS: Patients with chronic kidney disease require appropriate medication dosing for disease severity and level of renal function for avoiding adverse drug events, preventing additional renal injury, and optimizing patient outcomes. Consensus-based medication dosing guidelines are readily available and provide initial dose estimations, which can be further individualized based on disease severity and therapeutic response. Studies conducted in hospitals found renal dosing guideline noncompliance rates ranged from 19% to 67%. Limited data in long-term care reported a noncompliance rate of 34%. While published studies concerning compliance to renal dosing recommendations in ambulatory settings are not available, an abstract indicated 69% noncompliance.

CONCLUSIONS: Based on limited published data, improvements in renal dosing guideline compliance are needed in all settings where data are available. Research is needed to further assess the appropriateness of renal dosing in ambulatory settings and inform quality improvement efforts in all settings.

Key Words: chronic kidney disease, compliance, dosing guidelines, patient safety, renal insufficiency

Published Online, March 30, 2004. www.theannals.com, DOI 10.1345/aph.1D399

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-04-018-H01

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