Dosage Adjustment as an Efficiency in Treatment Costs for Chronic Kidney Disease Patients

Nurfina Dian Kartikawati; Fita  Rahmawati

doi:10.30595/jhepr.v2i1.120

Authors

Nurfina Dian Kartikawati Universitas Muhammadiyah Magelang
Fita Rahmawati Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia

DOI:

https://doi.org/10.30595/jhepr.v2i1.120

Keywords:

Adjustment dose, Chronic Kidney Disease, Cost

Abstract

Introduction: Chronic Kidney Disease (CKD) treatment, in all stages, has been shown to impose a big economic burden. To reduce drug costs, dose adjustment can be used in CKD treatment. Apart from saving costs, dose adjustments can also reduce the risk of side effects due to excessive doses. This research aimed to identify the dose suitability of CKD patient treatment and calculate the difference in treatment costs before and after the dose adjustments.

Method: This research was a cross-sectional study using descriptive analysis. Data was collected from medical records in UGM Academic Hospital using purposive nonrandom sampling in inpatient CKD patients with decreased creatinine clearance and serum creatinine who underwent hospitalization for at least one year.

Result: There were 58.14% male patients and 41.86% female patients. Most of the patients have stage 5 CKD (46.51%) and hypertension comorbidities (59.30%). Around 69.14% of drugs used in treatment required dose adjustment and only 52.33% of them had appropriate doses based on the Lexicomp Drug Information Handbook. The class of drugs that required the most dose adjustments was antibiotics with 14 occurrences. After the dose adjustment, the saved cost from patients with inappropriate doses was IDR 1,766,330. The biggest cost difference after the dose adjustment was IDR 1,090,865, which comes from the antibiotic group.

Conclusion: Dosage adjustments can reduce the incidence of medication errors, improve clinical outcomes, and increase the effectiveness of clinical outcomes and cost-effectiveness.

References

CDC. Chronic Kidney Disease in the United States 2021. Atlanta GA US Dep. Health Hum. Serv. Cent. Dis. Control Prev. 4 (2021).

Inker, L. A. et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am. J. Kidney Dis. Off. J. Natl. Kidney Found. 63, 713–735 (2014).

Kovesdy, C. P. Epidemiology of chronic kidney disease: an update 2022. Kidney Int. Suppl. 12, 7–11 (2022).

Hockham, C. et al. Sex differences in chronic kidney disease prevalence in Asia: a systematic review and meta-analysis. Clin. Kidney J. 15, 1144–1151 (2022).

Bikbov, B., Purcell, C. A., Levey, A. S., Smith, M. & et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet 395, 709–733 (2020).

Fluck, R. J. & Taal, M. W. What is the value of multidisciplinary care for chronic kidney disease? PLOS Med. 15, e1002533 (2018).

Yarnoff, B. O. et al. The cost-effectiveness of using chronic kidney disease risk scores to screen for early-stage chronic kidney disease. BMC Nephrol. 18, 85 (2017).

Saad, R. et al. Evaluation of renal drug dosing adjustment in chronic kidney disease patients at two university hospitals in Lebanon. Pharm. Pract. Granada 17, (2019).

Sah, S. K., Wanakamanee, U., Lerkiatbundit, S. & Regmi, B. M. Drug dosage adjustment of patients with impaired renal function at hospital discharge in a teaching hospital. J. Nepal Health Res. Counc. 12, 54–58 (2014).

Veryanti, P. R. & Meiliana, M. L. Evaluasi Kesesuaian Dosis Obat Pada Pasien Gagal Ginjal Kronik. SAINSTECH FARMA (2018).

Andriani, S., Rahmawati, F. & Andayani, T. M. Penyesuaian Dosis Obat pada Pasien Gagal Ginjal Kronis Rawat Inap di Rumah Sakit Kabupaten Tegal, Indonesia. Maj. Farm. 17, 46 (2021).

Akbari, A. et al. Canadian Society of Nephrology commentary on the KDIGO clinical practice guideline for CKD evaluation and management. Am. J. Kidney Dis. Off. J. Natl. Kidney Found. 65, 177–205 (2015).

Lexi-Comp, I. & American Pharmaceutical Association. Lexicomp Drug information handbook. (Wolters Kluwer, 2019).

Lewandowski, M. J. et al. Chronic kidney disease is more prevalent among women but more men than women are under nephrological care. Wien. Klin. Wochenschr. 135, 89–96 (2023).

Bikbov, B., Perico, N., Remuzzi, G., & on behalf of the GBD Genitourinary Diseases Expert Group. Disparities in Chronic Kidney Disease Prevalence among Males and Females in 195 Countries: Analysis of the Global Burden of Disease 2016 Study. Nephron 139, 313–318 (2018).

Pugh, D., Gallacher, P. J. & Dhaun, N. Management of Hypertension in Chronic Kidney Disease. Drugs 79, 365–379 (2019).

Ku, E., Lee, B. J., Wei, J. & Weir, M. R. Hypertension in CKD: Core Curriculum 2019. Am. J. Kidney Dis. 74, 120–131 (2019).

Hebert, S. A. & Ibrahim, H. N. Hypertension Management in Patients with Chronic Kidney Disease. Methodist DeBakey Cardiovasc. J. 18, 41–49.

Georgianos, P. I. & Agarwal, R. Hypertension in chronic kidney disease—treatment standard 2023. Nephrol. Dial. Transplant. gfad118 (2023) doi:10.1093/ndt/gfad118.

de Boer, I. H. et al. KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 98, S1–S115 (2020).

Ryan, D. K., Banerjee, D. & Jouhra, F. Management of Heart Failure in Patients with Chronic Kidney Disease. Eur. Cardiol. Rev. 17, e17 (2022).

Szlagor, M., Dybiec, J., Młynarska, E., Rysz, J. & Franczyk, B. Chronic Kidney Disease as a Comorbidity in Heart Failure. Int. J. Mol. Sci. 24, 2988 (2023).

Hendyatama, T. H. & Mardiana, N. Calculation of Drug Dosage In Chronic Kidney Disease. Curr. Intern. Med. Res. Pract. Surabaya J. 1, 21–24 (2020).

Kyriakopoulos, C. & Gupta, V. Renal Failure Drug Dose Adjustments. in StatPearls (StatPearls Publishing, 2023).

Aloy, B. et al. Antibiotics and chronic kidney disease: Dose adjustment update for infectious disease clinical practice. Médecine Mal. Infect. 50, 323–331 (2020).

Mistry, R., Moran, S. & Hughes, S. Dose adjustments of antimicrobials in patients with renal impairment. The Pharmaceutical Journal https://pharmaceutical-journal.com/article/ld/dose-adjustments-of-antimicrobials-in-patients-with-renal-impairment (2023).