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Abstract

RENAL DOSAGE ADJUSTMENT IN DIABETIC PATIENTS IN A TERTIARY CARE TEACHING HOSPITAL

Chippy B. Daniel, Dona Ann Abraham, Feba Mariam Chacko, Maneesh Koshy, Dr. Megha Mary Jose*

ABSTRACT

Introduction: Diabetes mellitus is a group of metabolic disorders of fat, carbohydrate, and protein metabolism that results from defects in insulin secretion, insulin action (sensitivity), or both. It’s hallmark clinical characteristics are symptomatic glucose intolerance resulting in hyperglycemia and alterations in lipid and protein metabolism. DM now ranks as the primary cause of End-Stage Kidney Disease (ESKD) requiring chronic renal replacement therapy. Decreased GFR and albuminuria are indicators of major health outcomes of this condition including End-Stage Renal Disease (ESRD) and death. Renal dysfunction may lead to accumulation of drugs and their metabolites. It may lead to toxicity of drugs. Therefore many drugs need adjustment can optimize therapeutic efficacy and minimize toxicity of drug. Objective: The primary objective of this study is to assess the renal dosage adjustment in diabetic patients. The secondary objective is to formulate dosage recommendation and to provide education and information regarding the disease and lifestyle modification. Materials and Methods: A prospective observational study was conducted on the renal dosage adjustment in diabetic patients in a tertiary care teaching hospital for a period of 6 months. Ethical clearance was obtained from the Institutional Ethical Committee. The study was conducted on 100 patients with Diabetes Mellitus. All inpatients diagnosed with diabetes irrespective of age and gender were included in the study. Patients who are not willing to participate in the study, patients with insufficient data in their records, Pregnant and pediatric patients, Comatose patients were excluded in the study. Prescribed dosage of drug was compared with dosage recommended by guidelines to assess appropriateness of dose in renal dysfunction. GFR was calculated by Cockcroft Gault equation. During ward rounds, cases were collected, and collected data were assessed and analyzed using Micromedex. Results: Out of 100 patients, 67 were males, and 33 were females, and majority of patients belonged to the age group between 51to 60 years. Out of 652 drugs prescribed in renal impaired patients, 60 drugs required dosage adjustment. The dosage recommendation in renal impairment was formulated based on CrCl using Micromedex software. Conclusion: The study effectively reported that the severity of renal impairment was measured using Cockcroft Gault and drug dosage adjustment was done using Micromedex software. 60 drugs required dosage adjustment in patients with renal impairment. We conclude that, in patients with renal impairment, the medication should be individualized depending on the need and severity of renal impairment.

Keywords: Renal Impairment, Diabetes Mellitus, Cockcroft Gault, Creatinine clearance, Dosage adjustment.


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