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National assessment of renal estimation for drug dosing among pharmacists
Author(s) -
McConachie Sean M.,
Hanni Claudia M.,
Raub Joshua N.,
Kucemba Megan,
Wilhelm Sheila M.
Publication year - 2019
Publication title -
journal of the american college of clinical pharmacy
Language(s) - English
Resource type - Journals
ISSN - 2574-9870
DOI - 10.1002/jac5.1057
Subject(s) - medicine , dosing , renal function , pharmacy , clinical pharmacy , creatinine , underweight , pharmacist , nephrology , kidney disease , overweight , family medicine , intensive care medicine , body mass index
Creatinine‐based equations used to estimate renal function are inaccurate in certain clinical contexts; however, there are limited resources to guide pharmacists in these situations. Objectives To assess current renal function estimation and subsequent drug dosing practices among American College of Clinical Pharmacy (ACCP) members via an electronic survey. Methods A 21‐item survey was emailed to the listservs of four ACCP Practice‐Research Networks: Adult Medicine, Nephrology, Critical Care, and Infectious Diseases. The survey included pharmacist demographics, practice site information, and case‐based clinical application scenarios requiring the respondent to choose a renal function estimate for overweight, underweight, and elderly patients (≥65 years). Four patient cases captured respondents' enoxaparin dosing decisions in patients with an estimated creatinine clearance of around 30 mL/min. Estimates of renal function were provided based on Cockcroft‐Gault (C‐G), Modification of Diet in Renal Disease, and Chronic Kidney Disease Epidemiology equations. Results There were 299 survey responses. The majority of respondents were pharmacists (98%) who practiced in the hospital setting (96%) as clinical specialists (69%). The C‐G equation was chosen to estimate renal function most commonly (85%). Total and adjusted body weights were used in C‐G estimates most commonly in patients who were underweight (80%) and overweight (75%), respectively. Given an elderly patient with low serum creatinine (S cr ), 34% of respondents used actual S cr , 30% rounded S cr to 0.8, and 29% rounded S cr to 1.0 for use in C‐G. Enoxaparin renal dose adjustment differed based on clinical indication. Respondents chose more frequent (every 12 hour) dosing in patients with pulmonary embolism vs atrial fibrillation. Of the 79% of respondents whose practice site utilizes pharmacist‐driven renal dose adjustment policies, 94% indicated they deviated from the policy. Conclusion Large variation exists among clinical pharmacists in the application of renal function estimating equations which may impact dosing strategies and patient care.