Drug dosage in patients with renal failure optimized by immediate concurrent feedback

Objective: To examine the impact of immediate concurrent feedback on dose adjustment in patients with renal failure. Design: prospective 12-month study in patients with various degrees of renal failure, with comparison to a retrospective control group. Setting: A 39-bed unit of a university hospital providing primary and tertiary care. Patients: Patients with renal failure (estimated creatinine clearance less than or equal to 50 mL/min) receiving at least 1 pharmacologically active drug. Interventions: Education of physicians and immediate concurrent feedback on the ward giving estimated creatinine clearance and dose recommendations for renally eliminated drugs adjusted to individual renal function. Measurements and Main Results: The percentage of dosage regimens adjusted to renal function and cost assessment of drug therapy were calculated. Overall, 17% of the patients had at least 1 estimated creatinine clearance less than or equal to 50 mL/min. In the intervention group, the dose of 81% of renally eliminated drugs was adjusted to renal function, compared with 33% in the control group (P <.001). The mean difference in cost between standard and adjusted dose of renally eliminated drugs in the intervention and control groups was 5.3 <plus/minus> 12.3 and 0.75 +/- 2.8 Swiss francs (approximately US$3.5 and US$0.5), respectively (P <.001), accounting for 16.5% and 2.8%, respectively, of daily medication costs of all drugs. Conclusions: The proportion of doses of renally eliminated drugs adjusted to renal function can be substantially increased by immediate concurrent feedback. This saves drug costs and has the potential to prevent adverse drug reactions.