title: Drug dosage adjustment in hospitalized patients with renal impairment at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia.
abstract: BACKGROUND
  Dose adjustment for certain drugs is required in patients with reduced renal function to avoid toxicity as many drugs are eliminated by the kidneys. The aim of this study was to assess whether appropriate dosage adjustments were made in hospitalized patients with renal impairment.
  
  
  METHODS
  A prospective cross-sectional study was carried out in the internal medicine wards of Tikur Anbessa Specialized Hospital. All patients with creatinine clearance ≤ 59 ml/min admitted to hospital between April and July, 2013 were included in the analysis. Data regarding serum creatinine level, age, sex and prescribed drugs and their dosage was collected from the patients' medical records. Serum creatinine level ≥ 1.2 mg/dL was used as a cutoff point in pre-selection of patients. The estimated creatinine clearance was calculated using the Cockcroft- Gault (CG) equation. Guideline for Drug prescribing in renal failure provided by the American College of Physicians was used as the standard for dose adjustment.
  
  
  RESULTS
  Nine percent (73/810) of medical admissions were found to have renal impairment (CrCl  ≤ 59 ml/min). There were 372 prescription entries for 73 patients with renal impairment. Dose adjustment was required in 31 % (115/372) of prescription entries and fifty eight (51 %) prescription entries requiring dose adjustment were found to be inappropriate. Of 73 patients, 54 patient received ≥ 1 drug that required dose adjustment (median 2; range 1-6). Fifteen (28 %) patients had all of their drugs appropriately adjusted while twenty two (41 %) patients had some drugs appropriately adjusted, and seventeen (31 %) of patients had no drugs appropriately adjusted. No patients were documented to have received dialysis.
  
  
  CONCLUSIONS
  The findings indicate that dosing errors were common among hospitalized patients with renal impairment. Improving the quality of drug prescription in patients with renal impairment could be of importance for improving the quality of care.
authors.affiliation: Department of Clinical Pharmacy, School of Pharmacy, College of Medical and Health Science, University of Gondar, Gondar, Ethiopia. heniget@gmail.com.
authors.forename: Henok
authors.initials: H
authors.lastname: Getachew
authors.affiliation: Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. yewondt@yahoo.com.
authors.forename: Yewondwossen
authors.initials: Y
authors.lastname: Tadesse
authors.affiliation: Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia. workineh.shibeshi@aau.edu.et.
authors.forename: Workineh
authors.initials: W
authors.lastname: Shibeshi
mesh_terms: D058186:Acute Kidney Injury / Q000503:physiopathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000008:administration & dosage; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage; D002442:Ceftazidime / Q000008:administration & dosage; D002927:Cimetidine / Q000008:administration & dosage; D003404:Creatinine / Q000097:blood / Q000652:urine; D003430:Cross-Sectional Studies; D004077:Digoxin / Q000008:administration & dosage; D004232:Diuretics / Q000008:administration & dosage; D054796:Drug Dosage Calculations; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004656:Enalapril / Q000008:administration & dosage; D005002:Ethiopia; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage; D006074:Gout Suppressants / Q000008:administration & dosage; D006760:Hospitalization; D006801:Humans; D008297:Male; D008508:Medication Errors; D008875:Middle Aged; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*; D012720:Severity of Illness Index; D013148:Spironolactone / Q000008:administration & dosage; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage; D014640:Vancomycin / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000889:Anti-Arrhythmia Agents; D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D000935:Antifungal Agents; D000959:Antihypertensive Agents; D004232:Diuretics; D006074:Gout Suppressants; D004364:Pharmaceutical Preparations; D013148:Spironolactone; D000493:Allopurinol; D004656:Enalapril; D014640:Vancomycin; D004077:Digoxin; D002927:Cimetidine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D015725:Fluconazole; D002442:Ceftazidime; D003404:Creatinine