Kidneys play crucial role in eliminating certain endogenous and exogenous substances. Kidney failure leads to accumulation of those substances, which can be eliminated via different dialysis methods. The purpose of our research was analysis of pharmacotherapy of patients undergoing acute renal replacement therapy in General Hospital dr. Franc Derganc Nova Gorica in 2018. We focused on adequacy of antimicrobial agents dosing according to different guidelines, such as The Renal Drug Handbook (TRDH) and NebraskaMed (NM) and Summary of product characteristics (SmPCs) of different medicines. Our study included 40 patients. Antimicrobial agents were prescribed in accordance with TRDH guidelines in 67,78 %, in 62,06 % with SmPCs and in 59,21 % in accordance with NM guidelines. For each antimicrobial medication prescribed we evaluated adequacy of dose, interval of dosing, time of dosing depending on time of dialysis and treatment effectiveness. In 76,19 % patients received adequate dose, in 58,44 % the dosing interval was adequate, in 68,57 % of cases the time of antimicrobial agent dosing was adequate. Spearman's coefficient for correlation between adequacy of dose and effectiveness was 0,236, for adequacy of dosing interval and effectiveness 0,402 and for time of dosing depending on time of dialysis and effectiveness was 0,258. Correlation between effectiveness and adequacy of dosing was weak to mild, according to calculated significance level only correlation between dosing interval and effectivness was significant (p=0,036). We evaluated the potential interactions between medicines prescribed, but none of them was clinically observed. Our main issue in evaluating medication dosing was absence of patient's body weight information in 75 % of cases, which would enable us to determine crucial parameter for evaluation of proper medicine dosing - creatinine clearance. Prescribing medicine dose according to »The Chronic Kidney Disease Collaboration« equation, which is used routinely in hospital environment, is not appropriate for patients with very high or very low body wight. Therapeutic drug monitoring in General Hospital dr. Franc Derganc Nova Gorica is available only for vancomycin and gentamicin. Clinical pharmacist participated in treatment of only one patient. To improve the quality of pharmacotherapy treatment in patients undergoing renal replacement therapy it would be worth considering the use of therapeutic drug monitoring also in other antimicrobial agents, when possible. Clinical pharmacist should be considered regular healthcare team member according to positive results of studies, which evaluated the clinical pharmacist's role in pharmacotherapy treatment of patients undergoing dialysis.
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