Medication-related problems in ambulatory hemodialysis patients: a pooled analysis.
BACKGROUND
Medication-related problems are common in hemodialysis (HD) patients. These patients often require 12 medications to treat 5 to 6 comorbid conditions. Medication-related problem research reports cannot be generalized to the entire HD population because data are obtained from single centers and limited numbers of patients. We conducted a pooled analysis to gain additional insight into the frequency, type, and severity of medication-related problems and extrapolated the data to the entire US HD population.


METHODS
Articles were identified through a MEDLINE search (1962 to March 2004). Seven studies were included in the analysis. Medication-related problems were categorized into the following 9 categories: indication without drug therapy, drug without indication, improper drug selection, subtherapeutic dosage, overdosage, adverse drug reaction, drug interaction, failure to receive drug, and inappropriate laboratory monitoring. A medication-related problem appearance rate was determined.


RESULTS
We identified 1,593 medication-related problems in 395 patients (51.2% men; age, 52.4 +/- 8.2 years; 42.7% with diabetes). The most common medication-related problems found were inappropriate laboratory monitoring (23.5%) and indication without drug therapy (16.9%). Dosing errors accounted for 20.4% of medication-related problems (subtherapeutic dosage, 11.2%; overdosage, 9.2%). The medication-related problem appearance rate was 5.75e(-0.37x), where x equals number of months of follow-up (P = 0.02).


CONCLUSIONS
HD patients experience ongoing medication-related problems. Reduction in medication-related problems in dialysis patients may improve quality of life and result in decreased morbidity and mortality. Pharmacists are uniquely trained to detect and manage medication-related problems. Pharmacists should be an integral member of the dialysis health care team.
Manley
Harold J
HJ
Albany College of Pharmacy, Albany, NY 12208, USA. manleyh@acp.edu
Cannella
Carrie A
CA
Bailie
George R
GR
St Peter
Wendy L
WL
D000328:Adult; D000368:Aged; D000465:Algorithms; D000553:Ambulatory Care; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy; D015331:Cohort Studies; D015897:Comorbidity; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions; D004700:Endocrine System Diseases / Q000150:complications / Q000188:drug therapy; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications / Q000188:drug therapy; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy; D007239:Infections / Q000150:complications / Q000188:drug therapy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy / Q000628:therapy; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000188:drug therapy; D008875:Middle Aged; D010045:Outpatients; D010146:Pain / Q000150:complications / Q000188:drug therapy; D010348:Patient Care Team; D004364:Pharmaceutical Preparations / Q000145:classification; D010595:Pharmacists; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D013927:Thrombosis / Q000150:complications / Q000188:drug therapy; D014481:United States / Q000453:epidemiology
D004364:Pharmaceutical Preparations