Page 11 - Pharmaquest issue 1 2020

DOSE ADJUSTMENT: PREVENTABLE DEATHS OF

RENAL IMPAIRED PATIENTS DUE TO MEDICINES IN

NEPALESE CONTEXT

UTTAM BUDHATHOKI, PhD, PDF

ASSOCIATE PROFESSOR
DEPARTMENT OF PHARMACY, KATHMANDU UNIVERSITY,
DHULIKHEL,KAVRE, NEPAL

INTRODUCTION

Chronic kidney(CKD) disease patients
are ever increasing and the management
of this disease is very expensive compared

to other chronic diseases(1). In a study incidence of kidney failure in Nepal
in Nepal, it is found that 87.5% of total is 3,000 and 1,000 people develop liver

respondents of kidney disease patients failure annually. Kidney and liver are
are in medication. There is international helping to excrete drug or in elimination
guidelines which categorize the condition of drug and if any one of them are

of kidney and decision to whether to adjust malfunctioning drug accumulation will
dose of medication or not, So far to my be there in patients’ body, which will lead

knowledge, there is no such guidelines in plasma drug concentration of drug to toxic
Nepal but our condition of CKD is ever level if we give normal dose to such kind
increasing .If we do not take action on of patients which ultimately killed the

this, it will accelerates to push mild kidney patients due to toxicity of medicine not
problem patients to End Stage Renal due to diseases which is never coming to

Disease [ESRD] and increase the burden highlight but blame is given to disease not
of dialysis frequency. Thus, it is high time medicine. This type of death is preventable
to check requirement of Dose Adjustment if we adjust the dose of medication to such

of medication in renal impaired patients. kind of patients. Dose Adjustment [DA]
This will save lives if it is in practice. This is is very essential in our context. Treatment

normal routine work abroad but it may be practice without DA in such type of
new concept here which is very essential patients is illegal in many developed
tool to save lives. countries, Thus there is a huge gap in
treatment practice in developed countries

Kidney transplantation originated and our context for such type of patients.

in the United States in 1954 and the
first successful transplant was done at
Tribhuvan University Teaching Hospital in

2008 in Nepal. This figure shows that how
behind we are in health care system. An

estimated figure shows that the 1