Medicine prescribing practices in renally-impaired patients admitted to the internal medicine wards at Dr George Mukhari Academic Hospital, Ga-Rankuwa, South Africa

Abstract

The number of patients with renal impairment has increased dramatically over the past few years, and in general, advances in the treatment of the disease have permitted patients to live longer. Clinicians tend to prescribe multiple medications, which can reduce renal function or cause impairment. This practice increases patient exposure to medicine dosage errors. The most commonly-prescribed medications in patients with renal impairment were identified and investigated in this study.The study was quantitative, retrospective and cross-sectional. Seven hundred and sixty-five medicines were prescribed in 100 reviewed patient files. An average of 7.7 medicines was prescribed per prescription. The most commonly-prescribed group of medicines was for the cardiovascular system (260, 33.9%). The most frequently-prescribed nephrotoxic medicine was perindopril (20.2%). Of the nephrotoxic medicines, which required a dose adjustment, just over half (57%) were adjusted according to the recommended guidelines for adult renal impairment. Only a small percentage (2.7%) of the prescribed nephrotoxic medicines should not have been prescribed for renally-impaired patients. This study emphasizes the importance of calculating the CrCl and implementing the appropriate medicine dose adjustments in renally impaired patients. Availability of clinical pharmacist in the wards can assist prescribers in minimizing medicine overdose and improve adherence to medicine dosage guidelines.

Keywords: Renal impairment, nephrotoxic medicines, dosage.