title: Awareness and current implementation of drug dosage adjustment by pharmacists in patients with chronic kidney disease in Japan: a web-based survey.
abstract: BACKGROUND
  The aims of this study were to evaluate the current awareness of and implementation by pharmacists in Japan of adjustment of drug dosage according to renal function (ADDR) in patients with chronic kidney disease (CKD) and to clarify the factors influencing implementation of ADDR by community pharmacists.
  
  
  METHODS
  We conducted a web-based questionnaire of Japanese community and hospital pharmacists. Responders were compared by characteristics, rate of implementation of ADDR, experience with adverse drug events, pharmacist awareness of implementation of ADDR, and obstacles to ADDR implementation experienced by pharmacists. Additionally, the factors influencing the implementation of ADDR by community pharmacists were investigated by logistic regression analysis.
  
  
  RESULTS
  Fewer community pharmacists had implemented ADDR than hospital pharmacists. The community pharmacists had less experience with adverse drug events caused by an inappropriate dosage than the hospital pharmacists, while the hospital pharmacists had encountered more severe adverse drug events than the community pharmacists. The community pharmacists had less awareness of ADDR implementation, and believed that problems in implementing ADDR were caused by a lack of information on the renal function of patients. In the logistic regression analysis, the factors influencing implementation of ADDR were "Routinely receiving prescriptions from nephrologists", "Experience with adverse drug events caused by inappropriate dosage for CKD patients", and "Awareness of the need for pharmacists to check the dosage of renally excreted drugs"; they did not include "Lack of information on patient renal function".
  
  
  CONCLUSIONS
  This study indicates that fewer Japanese community pharmacists than hospital pharmacists implement ADDR and that implementation of ADDR by community pharmacists is hindered by their limited awareness of the importance of patient renal function. We advocate that many countermeasures be introduced to prevent CKD patients from experiencing adverse drug events caused by inappropriate dosage. Such countermeasures would include a training program to educate pharmacists about the impact of impaired renal function on dosage of drugs that are excreted by the kidneys.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kondo
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Ishitsuka
authors.forename: Eri
authors.initials: E
authors.lastname: Shigemori
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Irikura
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kadowaki
authors.forename: Sumio
authors.initials: S
authors.lastname: Hirata
authors.forename: Takeshi
authors.initials: T
authors.lastname: Maemura
authors.forename: Tetsumi
authors.initials: T
authors.lastname: Irie
mesh_terms: D001364:Awareness; D004305:Dose-Response Relationship, Drug; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D007564:Japan; D007677:Kidney Function Tests; D008297:Male; D010594:Pharmacies; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D024382:Professional Role; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000188:drug therapy*; D011795:Surveys and Questionnaires