title: Adherence with Dosing Guideline in Patients with Impaired Renal Function at Hospital Discharge.
abstract: OBJECTIVE
  To determine the prevalence, determinants, and potential clinical relevance of adherence with the Dutch dosing guideline in patients with impaired renal function at hospital discharge.
  
  
  METHODS
  Retrospective cohort study between January 2007 and July 2011.
  
  
  METHODS
  Academic teaching hospital in the Netherlands.
  
  
  METHODS
  Patients with an estimated glomerular filtration rate (eGFR) between 10-50 ml/min/1.73 m(2) at discharge and prescribed one or more medicines of which the dose is renal function dependent.
  
  
  METHODS
  The prevalence of adherence with the Dutch renal dosing guideline was investigated, and the influence of possible determinants, such as reporting the eGFR and severity of renal impairment (severe: eGFR<30 and moderate: eGFR 30-50 ml/min/1.73 m(2)). Furthermore, the potential clinical relevance of non-adherence was assessed.
  
  
  RESULTS
  1327 patients were included, mean age 67 years, mean eGFR 38 ml/min/1.73 m(2). Adherence with the guideline was present in 53.9% (n=715) of patients. Reporting the eGFR, which was incorporated since April 2009, resulted in more adherence with the guideline: 50.7% vs. 57.0%, RR 1.12 (95% CI 1.02-1.25). Adherence was less in patients with severe renal impairment (46.0%), compared to patients with moderate renal impairment (58.1%, RR 0.79; 95% CI 0.70-0.89). 71.4% of the cases of non-adherence had the potential to cause moderate to severe harm.
  
  
  CONCLUSIONS
  Required dosage adjustments in case of impaired renal function are often not performed at hospital discharge, which may cause harm to the majority of patients. Reporting the eGFR can be a small and simple first step to improve adherence with dosing guidelines.
authors.affiliation: University Medical Center Utrecht, Department of Geriatrics, Utrecht, The Netherlands; Expertise Centre Pharmacotherapy for Old persons (Ephor), Utrecht, The Netherlands.
authors.forename: A Clara
authors.initials: AC
authors.lastname: Drenth-van Maanen
authors.affiliation: Expertise Centre Pharmacotherapy for Old persons (Ephor), Utrecht, The Netherlands; Jeroen Bosch Hospital, Department of Geriatrics, 's-Hertogenbosch, The Netherlands; VUmc, Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands.
authors.forename: Rob J
authors.initials: RJ
authors.lastname: van Marum
authors.affiliation: University Medical Center Utrecht, Department of Geriatrics, Utrecht, The Netherlands; Expertise Centre Pharmacotherapy for Old persons (Ephor), Utrecht, The Netherlands.
authors.forename: Paul A F
authors.initials: PA
authors.lastname: Jansen
authors.affiliation: University Medical Center Utrecht, Department of Clinical Pharmacy, Utrecht, The Netherlands.
authors.forename: Jeannette E F
authors.initials: JE
authors.lastname: Zwart
authors.affiliation: University Medical Center Utrecht, Department of Clinical Chemistry and Haematology, Utrecht, The Netherlands.
authors.forename: Wouter W
authors.initials: WW
authors.lastname: van Solinge
authors.affiliation: Expertise Centre Pharmacotherapy for Old persons (Ephor), Utrecht, The Netherlands; University Medical Center Utrecht, Department of Clinical Pharmacy, Utrecht, The Netherlands; Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmacoepidemiology and Pharmacotherapy, Faculty of Science, Utrecht University, Utrecht, the Netherlands.
authors.forename: Toine C G
authors.initials: TC
authors.lastname: Egberts
mesh_terms: D004305:Dose-Response Relationship, Drug; D005260:Female; D006761:Hospitals; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D009426:Netherlands; D010349:Patient Compliance; D010351:Patient Discharge; D017410:Practice Guidelines as Topic