In chronic kidney disease, the kidneys gradually lose their ability to filter waste products and regulate fluid and electrolyte balance in the body. Many medications are excreted through the kidneys, so patients with chronic kidney disease often require pharmacotherapy adjustments to prevent adverse drug reactions.
The aim of this retrospective clinical study was to evaluate pharmacotherapy optimization in residents of the Nova Gorica Retirement Home who were referred for a pharmacotherapy review in the second half of 2022 and in 2023 because of chronic kidney disease. We analyzed laboratory data, the number and types of prescribed medications, the consultant’s pharmacist recommendations and whether they were accepted by the attending physician.
The study included 55 patients (78,2 % women, median age 88 years). They were prescribed varying numbers of medications, with a median of 15. Most patients had advanced stages of chronic kidney disease (stages 3b, 4, or 5). In total, the consultant pharmacist made 87 therapy adjustment recommendations in seven category groups, including dose adjustment, kidney function monitoring, drug discontinuation, drug substitution, discouraged use, introduction of a new drug, and cases where no adjustment was needed. The most frequent were kidney function monitoring (26/87; 29,9 %) and dose adjustment (20/87; 23,0 %). At least one therapy adjustment was recommended for one or more active substances in the majority of patients (45/55: 81,8 %). These recommendations involved 31 different substances, most commonly statins, anticoagulants, and antidiabetics. The study showed that 89,7 % of the pharmacist’s recommendations were accepted by the physician, with drug discontinuation having the lowest acceptance rate (64,3 %).
The results highlight the importance of pharmacotherapy reviews in patients with chronic kidney disease to minimize adverse drug effects and optimize therapy.
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