gms | German Medical Science

15th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

20.11. - 21.11.2008, Bonn

Compliance with dosing guidelines in patients with chronic kidney disease on medical wards before and after an educational intervention

Einfluss einer einzeitigen Weiterbildungsveranstaltung und Bereitstellung eines webtools auf die Rate unangemessener Dosierungen bei niereninsuffizienten Patienten auf einer Allgemeinstation

Meeting Abstract

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  • S. Baum - Elisabethenstift Darmstadt, Innere Medizin, Darmstadt
  • W. Schneider - Elisabethenstift Darmstadt, Innere Medizin, Darmstadt
  • corresponding author S. Harder - Institut für Klinische Pharmakologie, Universitätsklinik Frankfurt am Main, Frankfurt am Main

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 15. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Bonn, 20.-21.11.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. Doc08gaa09

The electronic version of this article is the complete one and can be found online at:

Published: November 6, 2008

© 2008 Baum et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background and aim: In case of impaired renal function, dose adjustments of those drugs which are predominantly or exclusively excreted by the kidneys are typically given in the Summary of medicinal Product Characteristics (SmPC). However, compliance with these guidelines depends on knowledge of the actual creatinine clearance, which drugs are susceptible to renal failure, and how the dose is to be adjusted.

Material and methods: We observed the rate of inappropriate dosing schedules for a list of 25 drugs which were selected from the hospital formulary and which had clear recommendations (SmPC) in case of impaired renal function. After a 6-month observation period on medical wards of a community hospital (cohort 1), an educational intervention, accompanied with the free access of dosing software ( and a list of drugs under scrutiny were delivered to the medical staff. This intervention was followed by a further 6-months observation period (= cohort 2). In both cohorts, patients were included which had a reduced creatinine clearance (< 50 ml/min) measured on admittance.

Results: Cohort 1 included 37 male and 48 female patients (mean age 81 y), cohort 2 included 29 male and 28 female patients (mean age 77 y). The diagnosis leading to admittance was most often heart failure (N=20), COPD (N=6) or pneumonia (N=5). In cohort 1, 68% of all treatments with drugs from the above mentioned list (N=85) followed an unadjusted dosage. The leading drugs were torasemid (N=20), ramipril (N=13) and ranitidin (N=12). In cohort 2, only 34 % of all treatments (N=80) followed an unadjusted dosage (p < 0.01). The leading drugs in cohort 2 were ramipril (N=9), torasemid (N=4), ranitidin (N=4) and levofloxacin (N=3).

Conclusion: This intervention was on a „low key“-level, and no further approach e.g. academic detailing was effected. Despite this, we found a considerable reduction in the number of inappropriate doses in case of impaired renal function. It remains to be elucidated whether this approach translates in a measurable clinical benefit for patients.