Chronic kidney disease (CKD) affects 13% of adults in the United States, and acute renal failure (ARF) is present in up to 7% of hospitalized patients. Individuals with CKD are at an elevated risk for cardiovascular complications and anemia and have increased mortality. Mortality in ARF can be as high as 50%. Appropriate dosing of medications is important to avoid adverse drug events including further renal injury. Studies have shown that physicians are often nonadherent with renal dosing of medications. This may be because of unawareness as well as lack of skill in recognizing and executing renal adjustment. Because the house staff prescribes a large proportion of medications at academic medical centers, we set out to better understand how residents approach renal dosing of medications.
First‐, second‐, and third‐year internal medicine residents at 1 academic medical center were invited to participate in a 10‐question online survey to evaluate attitudes, knowledge, and skills in renal dosing of medications. The survey contained 5‐point Likert scales and multiple‐choice questions with the ability to write in additional answers.
Eighty‐nine of 151 internal medicine residents completed the survey (response rate, 59%). Renal dosing was considered important or very important by 100% of responders. Residents reported adjusting medications for renal clearance often or always 76% of the time. There was a significant increase in frequency of adjustment between PGY‐1 and PGY‐2 years (P = 0.007). Seventy‐five percent of residents endorsed feeling comfortable or very comfortable adjusting medications for decreased renal function, with a significant increase in comfort between the PGY‐1 and PGY‐2 years (P < 0.005). Residents reported being able to recognize medications that require renal dosing often or always 48% of the time, with a significant improvement from the PGY‐1 to PGY‐2 year (P < 0.005). Eighty percent of responders reported writing an order with the expectation that a pharmacist would adjust the dose, with no significant difference between PGY years. Every resident reported having orders adjusted by a pharmacist. There was a significant reduction in frequency of adjustment between the PGY‐2 and PGY‐3 years (P = 0.029).
Internal medicine residents understand the importance of renal adjustment of medications in hospitalized patients but lack the knowledge and skills to do so consistently and correctly. An intervention such as incorporation of pharmacists into daily rounds would provide oversight and education about renal dosing. In addition, an electronic medical order system with alerts for patients with reduced creatinine clearance or medications that require renal adjustment may improve recognition and execution of renal dosing.
K. Harrington ‐ University of Colorado Denver, resident; D. Levin ‐ University of Colorado Denver, employment; K. Schoepple ‐ University of Colorado Denver, resident; K. Lundin ‐ University of Colorado Denver, resident; L. Golightly ‐ University of Colorado Denver, employment
To cite this abstract:Harrington K, Levin D, Schoeppler K, Lundin K, Golightly L. Medication Adjustment in Renal Impairment: Insight Into the Resident Mind. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 54. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/medication-adjustment-in-renal-impairment-insight-into-the-resident-mind/. Accessed April 1, 2020.