CHRONIC-HEMODIALYSIS PATIENTS .1. CHARACTERIZATION AND DRUG-RELATED PROBLEMS

OBJECTIVE: To describe medication use in hemodialysis patients and to characterize the potential drug-related problems that may occur in thi s population. DESIGN: All patients being dialyzed during the study per iod who were responsible for taking their own medications and who were able to provide an accurate medication history were included in this study. A pharmacist administered a structured medication history and d rug therapy review protocol known as the Focused Drug Therapy Review P rogram to identify potential drug-related problems. This process was m odified for a hemodialysis population. SETTING: Outpatient hemodialysi s unit at a university-affiliate hospital. RESULTS: Thirty patients wi th endstage renal disease requiring hemodialysis were enrolled in the study. On average, 10 prescription and 2 prescribed nonprescription me dications were used per patient. The incidence of potential adverse ef fects and medication allergies or intolerances averaged 5.5 and 2.2 pe r patient, respectively. Twenty patients (67 percent) reported missing an average of 3.4 (range 1-11) doses of medication per month. A total of 216 potential drug-related problems (encompassing both prescribing choices and patient behaviors) were identified by the pharmacist; the categories of drug selection and medication compliance contained the greatest number of potential problems (24 and 23 percent, respectively ). CONCLUSIONS: Hemodialysis patients use a large number of medication s, which increases the risk for adverse reactions and other drug-relat ed problems. The types of potential drug-related problems identified a re amenable to pharmacist input. Thus, such patients should be targete d for clinical pharmacy intervention.