title: Medication misuse in hospitalized patients with renal impairment.
abstract: OBJECTIVE
  The potential consequences of medication misuse in renal impairment have not been assessed in a population of in-patients. The purpose of this study was to determine the frequency and potential consequences of a lack of dosage adjustment in hospitalized patients with renal impairment.
  
  
  METHODS
  Order sheets for in-patients having a creatinine above 0.7 mg/dl were analysed. We considered the appropriateness of prescriptions for medications having potential nephrotoxicity and/or eliminated through renal excretion or metabolism (TEM medications) and having manufacturer's guidelines for dosage adjustment in renal impairment.
  
  
  METHODS
  On the basis of these guidelines, each line of prescription was rated as 'appropriate order', 'inappropriate dosage', or 'contra-indicated order'. Experts also rated prescriptions as potentially fatal or severe, serious, significant, or without potential for increased adverse effects.
  
  
  RESULTS
  Two hundred and two order sheets were completed for 164 patients. They totalled 1469 lines of prescription, 85% of which were TEM medications, with guidelines for dosage adjustment for 71% of them (n = 886). Of these 886 prescriptions, 34% were inappropriate, 14% being contra-indicated and 20% with inappropriate dosage given the patient's renal function. Among the 202 order sheets, 75% included at least one inappropriate prescription. Sixty-three per cent included at least one prescription with potentially adverse consequences, 3% of these having potentially fatal or severe consequences.
  
  
  CONCLUSIONS
  This study confirms that physicians do not take into account sufficiently patient renal function when prescribing. In light of these results, improving the quality of drug prescription in patients with renal impairment could be of importance for improving the quality of care.
authors.affiliation: University Hospital Pitié Salpêtrière (AP-HP, Paris VI), Public Health Department, Paris, France. laurence.salomon@lmr.ap-hop-paris.fr
authors.forename: L
authors.initials: L
authors.lastname: Salomon
authors.forename: G
authors.initials: G
authors.lastname: Deray
authors.forename: M C
authors.initials: MC
authors.lastname: Jaudon
authors.forename: C
authors.initials: C
authors.lastname: Chebassier
authors.forename: P
authors.initials: P
authors.lastname: Bossi
authors.forename: V
authors.initials: V
authors.lastname: Launay-Vacher
authors.forename: B
authors.initials: B
authors.lastname: Diquet
authors.forename: J M
authors.initials: JM
authors.lastname: Ceza
authors.forename: S
authors.initials: S
authors.lastname: Levu
authors.forename: G
authors.initials: G
authors.lastname: Brücker
authors.forename: P
authors.initials: P
authors.lastname: Ravaud
mesh_terms: D000368:Aged; D011307:Drug Prescriptions; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000401:mortality / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000188:drug therapy*