Drug dosage in patients with renal failure optimized by immediate concurrent feedback

Objective: To examine the impact of immediate concurrent feedback on dose a djustment in patients with renal failure. Design: prospective 12-month study in patients with various degrees of rena l failure, with comparison to a retrospective control group. Setting: A 39-bed unit of a university hospital providing primary and terti ary care. Patients: Patients with renal failure (estimated creatinine clearance less than or equal to 50 mL/min) receiving at least 1 pharmacologically active d rug. Interventions: Education of physicians and immediate concurrent feedback on the ward giving estimated creatinine clearance and dose recommendations fo r renally eliminated drugs adjusted to individual renal function. Measurements and Main Results: The percentage of dosage regimens adjusted t o renal function and cost assessment of drug therapy were calculated. Overa ll, 17% of the patients had at least 1 estimated creatinine clearance less than or equal to 50 mL/min. In the intervention group, the dose of 81% of r enally eliminated drugs was adjusted to renal function, compared with 33% i n the control group (P <.001). The mean difference in cost between standard and adjusted dose of renally eliminated drugs in the intervention and cont rol groups was 5.3 <plus/minus> 12.3 and 0.75 +/- 2.8 Swiss francs (approxi mately US$3.5 and US$0.5), respectively (P <.001), accounting for 16.5% and 2.8%, respectively, of daily medication costs of all drugs. Conclusions: The proportion of doses of renally eliminated drugs adjusted t o renal function can be substantially increased by immediate concurrent fee dback. This saves drug costs and has the potential to prevent adverse drug reactions.