title: Pattern and Predictors of Medication Dosing Errors in Chronic Kidney Disease Patients in Pakistan: A Single Center Retrospective Analysis.
abstract: BACKGROUND
  Chronic kidney disease (CKD) alters the pharmacokinetic and pharmacodynamic response of various drugs and increases the risk of toxicity. The data regarding the pattern and predictors of medication dosing errors is scare from the developing countries. Therefore, the present study was conducted to assess the pattern and predictors of medication dosing errors in CKD patients in a tertiary care setting in Pakistan.
  
  
  METHODS
  A retrospective study design was employed and medical charts of all those CKD patients who had an eGFR ≤60ml/min/1.73m2, hospitalization ≥24 hours, and admitted in the nephrology unit during January 2013 to December 2014 were assessed. Descriptive statistics and the logistic regression analysis were done using IBM SPSS version 20.
  
  
  RESULTS
  In total, 205 medical charts were assessed. The mean age of patients was 38.64 (±16.82) years. Overall, 1534 drugs were prescribed to CKD patients, of which, nearly 34.0% drugs required dose adjustment. Among those drugs, only 41.8% were properly adjusted, and the remaining 58.2% were unadjusted. The logistic regression analysis revealed that the medication dosing errors were significantly associated with the CKD stages, i.e. stage 4 (OR 0.054; 95% CI [0.017-0.177]; p <0.001) and stage 5 (OR 0.098; 95% CI [0.040-0.241]; p <0.001), the number of prescribed medicines ≥ 5 (OR 0.306; 95% CI [0.133-0.704]; p 0.005), and the presence of a comorbidity (OR 0.455; 95% CI [0.226-0.916]; p 0.027) such as the hypertension (OR 0.453; 95% CI [0.231-0.887]; p 0.021).
  
  
  CONCLUSIONS
  It is concluded that more than half drugs prescribed to CKD patients requiring dose adjustment were unadjusted. The predictors of medication dosing errors were the severe-to-end stages of chronic kidney disease, the presence of a comorbidity such as hypertension, and a higher number of prescribed medicines. Therefore, attention should be paid to these risk factors.
authors.affiliation: Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan.
authors.forename: Ahsan
authors.initials: A
authors.lastname: Saleem
authors.affiliation: Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan.
authors.forename: Imran
authors.initials: I
authors.lastname: Masood
mesh_terms: D000328:Adult; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006760:Hospitalization; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D010154:Pakistan; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D055815:Young Adult