title: Medication-related problem type and appearance rate in ambulatory hemodialysis patients.
abstract: BACKGROUND
  Hemodialysis (HD) patients are at risk for medication-related problems (MRP). The MRP number, type, and appearance rate over time in ambulatory HD patients has not been investigated.
  
  
  METHODS
  Randomly selected HD patients were enrolled to receive monthly pharmaceutical care visits. At each visit, MRP were identified through review of the patient chart, electronic medical record, patient interview, and communications with other healthcare disciplines. All MRP were categorized by type and medication class. MRP appearance rate was determined as the number of MRP identified per month/number of months in study. The number of MRP per patient-drug exposures were determined using: [[(number of patients) x (mean number of medications)]/(number of months of study)] /number of MRP identified. Results were expressed as mean +/- standard deviation or percentages.
  
  
  RESULTS
  Patients were 62.6 +/- 15.9 years old, had 6.4 +/- 2.0 comorbid conditions, were taking 12.5 +/- 4.2 medications, and 15.7 +/- 7.2 doses per day at baseline. Medication-dosing problems (33.5%), adverse drug reactions (20.7%), and an indication that was not currently being treated (13.5%) were the most common MRP. 5,373 medication orders were reviewed and a MRP was identified every 15.2 medication exposures. Overall MRP appearance rate was 0.68 +/- 0.46 per patient per month.
  
  
  CONCLUSIONS
  MRP continue to occur at a high rate in ambulatory HD patients. Healthcare providers taking care of HD patients should be aware of this problem and efforts to avoid or resolve MRP should be undertaken at all HD clinics.
authors.affiliation: University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA. manleyh@umkc.edu
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Manley
authors.forename: Debra K
authors.initials: DK
authors.lastname: Drayer
authors.forename: Richard S
authors.initials: RS
authors.lastname: Muther
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D048909:Diabetes Complications; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis