Abstract of a poster presentation at the 2016 National Medicines Symposium, 19-20 May, Canberra, Australia

Blaze, Julie M

Frew, Haley

Hall, Jeffrey G

Jordan, Margaret L

Mullan, Judy

Stewart, Adele F

English

Research Online

University of WollongongResearch OnlineFaculty of Science, Medicine and Health - Papers Faculty of Science, Medicine and Health2016"Use with caution in renal impairment" -implications for drug dosing in the general practicesettingMargaret L. JordanWoonona Medical Pratice, mjordan@uow.edu.auAdele F. StewartWoonona Medical Pratice, adeles@uow.edu.auJulie M. BlazeBulli Medical Pratice, jblaze@uow.edu.auJeffrey G. HallBulli Medical Pratice, jeffreyh@uow.edu.auHaley FrewWoonona Medical Pratice, hkf996@uowmail.edu.auSee next page for additional authorsResearch Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library:research-pubs@uow.edu.auPublication DetailsJordan, M., Stewart, A., Blaze, J., Hall, J., Frew, H. & Mullan, J. (2016). "Use with caution in renal impairment" - implications for drugdosing in the general practice setting. National Medicines Symposium 2016: Poster Abstracts (pp. 167-167). Australia: NPS."Use with caution in renal impairment" - implications for drug dosing inthe general practice settingAbstractAbstract of a poster presentation at the 2016 National Medicines Symposium, 19-20 May, Canberra, Australia.DisciplinesMedicine and Health Sciences | Social and Behavioral SciencesPublication DetailsJordan, M., Stewart, A., Blaze, J., Hall, J., Frew, H. & Mullan, J. (2016). "Use with caution in renal impairment"- implications for drug dosing in the general practice setting. National Medicines Symposium 2016: PosterAbstracts (pp. 167-167). Australia: NPS.AuthorsMargaret L. Jordan, Adele F. Stewart, Julie M. Blaze, Jeffrey G. Hall, Haley Frew, and Judy MullanThis conference paper is available at Research Online: http://ro.uow.edu.au/smhpapers/3763  167Poster abstracts  379 - “Use with caution in renal impairment” – implications for drug dosing in the general practice settingJordan M1, Stewart A1, Blaze J2, Hall J2, Frew H1, Mullan J31Woonona Medical Pratice, 2Bulli Medical Practice, 3School or Medicine, University of Wollongong Introduction: The number of medicines requiring attention in declining kidney function, and prescribed by GPs, is growing. A clinical pharmacist was integrated within a general practice, to investigate the management of anticoagulants. The results highlighted the implications of using readily available estimates (uncorrected Glomerular Filtration Rate, “eGFR”) for dosing of the non-vitamin K antagonist oral anticoagulants (NOACs) and informed a second project in a separate practice.Aims: To describe how kidney function is assessed in two general practices, the implications on use of renally-excreted medicines and the impact of a pharmacist.Methods: Two general practice research projects were undertaken. Study 1 investigated the impact of the pharmacist on the management of warfarin and NOACs, compared to the results from a retrospective review. Study 2 assessed appropriateness of medicine management in patients over 65 with impaired kidney function, before and after pharmacist input. Medicines most commonly prescribed were targeted. Estimates of kidney function were compared (eGFR and calculated creatinine clearance [eCrCl]) in both studies.Results: Study 1: Prior to pharmacist input, eGFR was used to guide drug-dosing of NOACS: usage was appropriate for 50% patients compared to 100% at the study close (P = 0.0245). Study 2: The appropriateness of management of the target medicines (pregabalin, NOACS, antidiabetic agents, statins, digoxin) improved from 42% to 88% (P<0.0001) despite similarities in measures of kidney function (P=0.4872). The means of kidney function metrics (eGFR vs eCrCl) differed significantly from each other in both stages: 63mL/min/1.73m² vs 47mL/min; (P <0.001.)Implications for practice change: Significant differences in the estimates of kidney function lead to discrepancies in drug dosing, particularly for the NOACs. GPs have an ever-increasing range of medicines to manage, with competing sources for guidance. The input of a clinical pharmacist can improve the management of medicines in kidney impairment in general practices. 

Use with caution in renal impairment  - implications for drug dosing in the general practice setting

https://ro.uow.edu.au/cgi/viewcontent.cgi?article=4786&context=smhpapers

Use with caution in renal impairment - implications for drug dosing in the general practice setting

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