Renally Relevant Drug List Could Be an Effective Tool in Treatment Plans for Renal Insufficient Patients

A 2021 study published in the European Journal of Hospital Pharmacy shows that the creation of a renally relevant drug (RRD) list may guide providers to optimize therapy in patients with chronic kidney disease (CKD).

CKD is a common condition that is often a consequence of other comorbid diseases. Increased age, hypertension, obesity, and diabetes are risk factors that contribute to CKD’s development and progression. CKD progression can cause loss of metabolic and endocrine control, which increases the risk of drug-related problems. Providers must carefully prescribe, monitor, and adjust RRDs in patients with CKD to prevent progression of the disease, control chronic diseases, and prevent adverse drug reactions.

Providers must rely on many resources to create treatment plans in patients with CKD. Resources and studies may contradict each other, making it difficult for providers to choose suitable dosing strategies. The purpose of the RRD list was to summarize data and provide specific recommendations to guide proper provider prescribing.

A clinical pharmacist created a list of RRDs by reviewing charts from an outpatient clinic. The pharmacist looked at current medication lists and possible drug-related problems.

Nephrologists gave recommendations on what they believed should be on the list.

Drugs were classified as a RRD if they had 1 or more of the following characteristics:

• Frequently used by nephrologists to maintain renal function
• Requires renal dose adjustments
• Contraindicated in certain stages of CKD
• Used for treatment of CKD-associated conditions

The pharmacist reviewed 160 patient charts that included 1376 different medications. Of these, 831 were deemed renally relevant.

The most frequently detected RRD groups were diuretics, RAAS inhibitors, HMG CoA reductase inhibitors, antihypertensives, gout therapeutics, oral and parenteral antidiabetics, oral anticoagulants, non-opioid analgesics, and vitamin D analogs. Nephrologists used the RRD list in an outpatient nephrological clinic to make 292 recommendations.

This study had a few major limitations mostly related to the patient population. Researchers only looked at 1 outpatient clinic and the list is not inclusive of all RRDs, therefore it may not be helpful in other patient populations, such as inpatient. However, this study is a strong start for potential future research in this field. RRD lists could play an essential role in the future of CKD management.

About the Author

Jessica Dillon is a 2023 PharmD candidate at the University of Connecticut.

Reference

Schütze A, Benöhr P, Haubitz M, Radziwill R, Hohmann C. Development of a list with renally relevant drugs as a tool to increase medicines opotimisation in patients with chronic kidney disease. Eur J Hosp Pharm. 2023;30(1):46-52. doi:10.1136/ejhpharm-2020-002571