title: Factors associated with medication-related problems in ambulatory hemodialysis patients.
abstract: BACKGROUND
  Hemodialysis (HD) patients are at risk for medication-related problems. Patient characteristics associated with the number of medication-related problems in HD patients have not been investigated.
  
  
  METHODS
  Patient records were reviewed to identify medical problems, prescribed medications, medication indication(s), and medication-related problems. Medication classes and medication-related problems were compared between patients with and without diabetes mellitus (DM). Correlations were performed to determine whether associations exist between medication-related problems, number of medications, number of medication doses per day, number of comorbid conditions, patient age, and duration of end-stage renal disease while controlling for DM status.
  
  
  RESULTS
  Medical records of 133 patients were evaluated. Patients were 60.5 +/- 15.2 years old, prescribed 11.0 +/- 4.2 medications, and had 6.0 +/- 2.3 comorbidities. Medication-related problems were identified in 97.7% of patients. Four hundred seventy-five medication-related problems were identified, averaging 3.6 +/- 1.8 medication-related problems per patient. Patients with DM had more medication-related problems identified than those without DM (303 versus 172 medication-related problems, respectively; P < 0.05). Medication-related problems correlated positively with number of patient comorbidities (P < 0.001).
  
  
  CONCLUSIONS
  Medication-related problems are prevalent in virtually all HD patients. The number of medication-related problems in an individual patient increases as the number of comorbid conditions increases. The most frequent medication-related problems were drug without indication (30.9%), laboratory (27.6%), indication without drug use (17.5%), and dosing errors (15.4%). Patients with DM are at increased risk for medication-related problems. Health care providers taking care of HD patients should be aware of this problem, and efforts to avoid or resolve medication-related problems should be undertaken at all HD clinics.
authors.affiliation: University of Missouri-Kansas City, School of Pharmacy; Dialysis Clinic, Inc. MO, USA. manleyh@umkc.edu
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Manley
authors.forename: Marcy L
authors.initials: ML
authors.lastname: McClaran
authors.forename: Debra K
authors.initials: DK
authors.lastname: Overbay
authors.forename: Marcia A
authors.initials: MA
authors.lastname: Wright
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Reid
authors.forename: Walter L
authors.initials: WL
authors.lastname: Bender
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Neufeld
authors.forename: Sudarshan
authors.initials: S
authors.lastname: Hebbar
authors.forename: Richard S
authors.initials: RS
authors.lastname: Muther
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications / Q000188:drug therapy; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007239:Infections / Q000150:complications / Q000188:drug therapy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data / Q000639:trends*; D001523:Mental Disorders / Q000150:complications / Q000188:drug therapy; D008875:Middle Aged; D010146:Pain / Q000150:complications / Q000188:drug therapy; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods / Q000639:trends*; D011537:Pruritus / Q000150:complications / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors