Evaluation of Pharmaceutical Interventions for Dose Adjustment in Critically Ill Patients with Renal Dysfunction

Abstract

Objective: To evaluate pharmaceutical interventions for dose adjustments in renal failure patients in intensive care units (ICUs), considering acceptance by prescribers and the distribution of medications by therapeutic class. Methods: This prospective crosssectional study was conducted from November 1, 2024, to January 31, 2025, involving critically ill patients with acute or chronic renal insufficiency. Prescriptions from patients in the hospital’s four ICUs (Adult General ICU, Neonatal ICU, Pediatric ICU, and Cardiac ICU) requiring dose adjustments based on renal function (GFR < 60 mL/min/1.73 m² or on dialysis) were included. Prescriptions of patients with normal renal function (GFR > 60 mL/min/1.73 m²) or those with correct dose adjustments by the prescriber were excluded. Interventions were recorded in the Soul MV system, based on UpToDate, Micromedex, and Sanford Guide, and were performed through rounds, direct, or telephone contact. Medications were classified using the Anatomical Therapeutic Chemical Classification System (ATC). Results: A total of 2,616 prescriptions were analyzed, of which 96.9% did not require dose adjustment. In 80 prescriptions (3.1%), the adjustment was needed but not performed. Clinical pharmacists made 109 interventions in 41 patients with renal injury. Most interventions (71.6%) were based on GFR, and 28.4% were based on dialysis modality. The acceptance rate of interventions was 68.8%. The adjusted medications were primarily anti-infectives (78%), followed by hematological agents (14%), cardiovascular (4%), nervous system (3%), and gastrointestinal (1%). Conclusion: The study highlights the importance of clinical pharmacists in dose adjustment management for critically ill patients with renal dysfunction, emphasizing their role in improving treatment safety and efficacy.