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Evaluation of dosage adjustment in patients with renal impairment

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Abstract Aims:

To determine whether appropriate dosage adjust¬≠ments are made in patients with significant renal impairment for drugs with a high fractional renal clearance. Methods: 

Evaluation of dosage adjustment was performed in patients who were admitted to a 480-bed metropolitan hospital (Princess Alexandra Hospital, Brisbane, Australia) with an estimated creatinine clearance of ≤40 mL/min. All drugs had a high fractional renal excretion. A prescribed dose within 30% of the calculated dose was considered appropriate. Results: 

Doses were found to be inappropriately high in 105 (42.2%) of 249 admission prescriptions of the targeted drugs. Doses were appropriately reduced in hospital in 32 patients (30.4%). Seventy-three (29.3%) prescriptions were continued with excessive doses. Only 34 prescriptions for the target drugs were initiated in hospital, of which 88.2% were appropriately dosed. Conclusions: 

A significant percentage of patients with renal impairment are admitted to hospital on inappro¬≠priately high doses of drugs, with a high fractional renal excretion and low therapeutic index. Doses are appropriately reduced in hospital in some patients but there is still room for improvement. (Intern Med J 2003; 33: 10−13)

Keywords: adjustment; dosage; drug; renal impairment

Document Type: Research Article


Affiliations: Department of Clinical Pharmacology, Princess Alexandra Hospital, Brisbane, Queensland, Australia

Publication date: January 1, 2003


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