Page 12 - Pharmaquest issue 1 2020

In Europe, Dose adjustment has to be done is required in the patient or not with the
if renal function is : help of Table 1. In most of the country,
GROUP Description GFR(ml/min Dose adjustment is advised if creatinine

1.73 M2) cleatrence is below 50 or in the category of
mild renal impairment or below.
1 Normal Renal >80
Function Pharmacists’ intervention is required

2 Mild Renal 50-80 in dose adjustment in renal and hepatic
Impairment impaired patients. This could save lives,
3 Moderate Renal 30-<50 otherwise medicines kill patients. This is

Impairment
preventable and has to take action instantly
if we want to prevent patients from early
4 Severe renal <30
impairment death or deterioration of health condition of

5 End Stage Renal Requiring patients.
Disease (ESRD) Dialysis
For this Pharmacists need to be

METHODOLOGY knowledgeable and skillful. Lets prevent
patients from Adverse Drug reactions
For this study, age, weight, height and (ADRs) due to drug accumulation or over
serum concentration of creatinine of the medication. Its preventable and lets prevent

patients are required. Before dialysis, blood patients from death due to medicines.
test will be done, thus serum creatinine

value will be obtained from there. Lean
body weight of the patient (LBW) will be REFERENCES
calculated using the following formula: 1. P MDK. Status of Chronic Kidney
Disease Patients Registered in National

LBW[male]= 50+2.3×inches more than 5 Kidney Center, Banasthali, Kathmandu.

feet. JMMIHS. 2015;1(4):19-23.
2. Enns J AG. A path to renal

LBW[Female]= 45.5+2.3×inches more than transplantation in Nepal. Journal of

5 feet Pathology of Nepal. 2011;1:52-5.
3. use EMAEomfH. <note-guidance-

Then, Cock Croft and Gault equation will evaluation-pharmacokinetics-medical-
be used to calculate creatinine clearance(3): products-patients-impaired-renal-
Cock croft and gault: function_en.pdf>. CHMP/EWP. 23 June
2004;225(02).

Creatinine clearance (CRCl)= 4. <Applied Biopharmaceutics and

((140-age)×body weight in kilograms)/ Pharmacokinetics, 7th Edition.pdf>.A
(72×Serum creatinine concentration)×0.85
(if female)

Based on creatinine clearance, it has to

be decided to whether dose adjustment 2