title: Use of off-label nephrology-related drugs in hospitalized pediatric patients: a retrospective study.
abstract: BACKGROUND
  The information about the use of off-label drugs in pediatric nephrology is still lacking, which leads to increased adverse reactions and medical disputes. We retrospectively analyzed the use of off-label drugs in the in-patient ward of the nephrology department of Nanjing Children's Hospital, China in order to provide more complete information about the use of drugs for children.
  
  
  METHODS
  Proportional stratified random sampling was applied to select patients with renal diseases aged 1 month to 18 years, who were admitted to the hospital from October 1, 2012 to September 30, 2013. All nephrology-related drugs prescribed in the hospitalization period and take-home drugs prescribed on discharge were recorded and evaluated as off-label drugs or not from three different perspectives: person-time, prescription, and drug category.
  
  
  RESULTS
  From 385 person-times of patients with 1424 prescriptions, according to the ratio between off-label drugs and person-times, drug prescriptions, and drug products, the rates of off-label drugs were 40.78%, 16.64%, and 31.43%, respectively. Low-molecular-weight heparin, alfacalcidol and diltiazem were the most commonly used off-label drugs. Infants and younger children were the high-risk population of off-label drug use. The high rate off-label nephrology-related drug use in children was mainly related to lacking clinical research into drugs in children and the pace of drug label's revision, which cannot follow the development of medical science.
  
  
  CONCLUSIONS
  Approximaely half of pediatric patients with renal diseases are usually prescribed with off-label nephrology-related drugs. Analyzing the off-label conditions from different perspectives may lead to various results. More clinical research into drugs for infants and younger children is needed so as to update drug descriptions.
authors.affiliation: Department of Nephrology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China.|Jiangsu Key Laboratory of Pediatrics, Nanjing, China.
authors.forename: Marchella
authors.initials: M
authors.lastname: Yasinta
authors.affiliation: Department of Nephrology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China.|Jiangsu Key Laboratory of Pediatrics, Nanjing, China.
authors.forename: Ruo-Chen
authors.initials: RC
authors.lastname: Che
authors.affiliation: Department of Nephrology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China.|Jiangsu Key Laboratory of Pediatrics, Nanjing, China.
authors.forename: Cai-Yu
authors.initials: CY
authors.lastname: Hu
authors.affiliation: Department of Nephrology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China.|Jiangsu Key Laboratory of Pediatrics, Nanjing, China.
authors.forename: Xiang-Hui
authors.initials: XH
authors.lastname: Du
authors.affiliation: Department of Nephrology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China.|Jiangsu Key Laboratory of Pediatrics, Nanjing, China.
authors.forename: Gui-Xia
authors.initials: GX
authors.lastname: Ding
authors.affiliation: Department of Nephrology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China.|Jiangsu Key Laboratory of Pediatrics, Nanjing, China.
authors.forename: Song-Ming
authors.initials: SM
authors.lastname: Huang
authors.affiliation: Department of Nephrology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China. xychen0929@sina.com.|Jiangsu Key Laboratory of Pediatrics, Nanjing, China. xychen0929@sina.com.|Department of Nephrology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210029, China. xychen0929@sina.com.
authors.forename: Ying
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Nephrology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China.|Jiangsu Key Laboratory of Pediatrics, Nanjing, China.
authors.forename: Ai-Hua
authors.initials: AH
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002681:China; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000188:drug therapy*; D008297:Male; D056687:Off-Label Use / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: in-patient; kidney; off-label drug; pediatrics