2022 Volume 11 Issue 2 Pages 173-177
Patients with chronic kidney disease (CKD) have a high risk of renal adverse events from drugs excreted by the kidney, and caution is needed when using these drugs. We speculated that the types of drugs associated with suspected overdoses due to reduced renal function may differ between those prescribed by hospitals and those prescribed by clinics. Therefore, in this study, we surveyed the drugs that CKD patients were prescribed by medical institutions and assessed the incidence of suspected overdose and the drugs involved. Suspected overdose was determined in accordance with the recommendations of the Japanese Society of Nephrology and Pharmacotherapy based on the patients’ CKD stage. We examined 1,049 patients and 66 (6.3%) were determined to have suspected overdose associated with 75 drugs. Thirty-four of these drugs (58%) were prescribed by hospitals for patients with CKD stage 2–3, while 10 (63%) were prescribed by clinics for patients with CKD stage 4–5. Thus, more clinics than hospitals prescribed drugs associated with suspected overdose for patients with more advanced CKD. The drugs associated with suspected overdose included 11 H2-blockers 8 antidiabetics, anti-allergic drugs, and urate-lowering drugs, and 7 antibiotics. Hospitals prescribed a significantly higher number of antidiabetics associated with suspected overdose than clinics (P = 0.03), whereas clinics prescribed significantly higher numbers of antipsychotics and antibiotics associated with suspected overdose than hospitals (P = 0.03 and P = 0.17, respectively). Our findings clarify that drugs associated with suspected overdose differ depending on the prescribing medical institution. These findings could help pharmacists working in hospitals and community pharmacies to be aware of potential cases of suspected overdose due to reduced kidney function. Also, monitoring patients’ renal function is important because the drugs associated with suspected overdose were taken daily and were commonly prescribed. Pharmacists can help to prevent overdose in CKD patients by monitoring their renal function through cooperation between hospital and community pharmacists, use of a CKD sticker to alert pharmacists, and provision of laboratory data on the prescriptions issued.
