title: [Questionnaire surveying nephrologists on drug dose adjustment in patients with impaired kidney function].
abstract: OBJECTIVE
  Our intention was to assess knowledge and requirements related to drug dose adjustment in patients with impaired kidney function.
  
  
  METHODS
  In 2005, we sent a questionnaire containing 22 questions to nephrologists in Germany and Austria. With 77 responses, the study was not representative. However, it was probably of importance for the target group of practising physicians and potential users of a future drug information system.
  
  
  RESULTS
  Only 28% of the responding colleagues use the package inserts; these are obviously not considered to be an obligatory guideline for dose adjustment. The most common dosing problems (p < 0.05) were associated with anti-infective (48%) and anti-cancer drugs (25%). The greatest problems with dosing were encountered within intensive care units (29%). The risk of excessive dosing is estimated significantly more serious than the risk of underdosing (51% vs. 23%, p = 0.02). There was support for the statement that for cephalosporin antibiotics the trough levels are more important than peak levels (58% vs. 27%, p < 0.01). However, only 8% knew that in patients with impaired kidney function, trough concentrations of aminoglycosides and vancomycin need to be higher than in patients with normal kidney function for adequate peak levels to be obtained. Forty-five percent of respondents erroneously presumed that ceftriaxone must be adjusted to the kidney function. Half of the respondents were incorrect in assuming that ceftriaxone or moxifloxacin would be removed by dialysis.
  
  
  CONCLUSIONS
  We see the need for more knowledge-based information on drug dosing in patients with kidney impairment and those in the intensive care unit. The risk to life posed by underdosage might be underestimated, especially for anti-infective drugs.
authors.affiliation: Nephrologie, Medizinische Fakultät, Universität Ulm, Ulm, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Maus
authors.forename: Caecilia
authors.initials: C
authors.lastname: Holch
authors.forename: David
authors.initials: D
authors.lastname: Czock
authors.forename: Florian
authors.initials: F
authors.lastname: Thalhammer
authors.forename: Frieder
authors.initials: F
authors.lastname: Keller
authors.forename: Bertram
authors.initials: B
authors.lastname: Hartmann
mesh_terms: D004334:Drug Administration Schedule; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D009398:Nephrology / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires