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      Medication-related problems in ambulatory hemodialysis patients: a pooled analysis.

      American Journal of Kidney Diseases

      Adult, Aged, Algorithms, Ambulatory Care, Cardiovascular Diseases, complications, drug therapy, Cohort Studies, Comorbidity, Drug Interactions, Drug-Related Side Effects and Adverse Reactions, Endocrine System Diseases, Female, Gastrointestinal Diseases, Humans, Hyperlipidemias, Infection, Kidney Failure, Chronic, therapy, Male, Mental Disorders, Middle Aged, Outpatients, Pain, Patient Care Team, Pharmaceutical Preparations, classification, Pharmacists, Prospective Studies, Randomized Controlled Trials as Topic, Renal Dialysis, Thrombosis, United States, epidemiology

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          Medication-related problems are common in hemodialysis (HD) patients. These patients often require 12 medications to treat 5 to 6 comorbid conditions. Medication-related problem research reports cannot be generalized to the entire HD population because data are obtained from single centers and limited numbers of patients. We conducted a pooled analysis to gain additional insight into the frequency, type, and severity of medication-related problems and extrapolated the data to the entire US HD population. Articles were identified through a MEDLINE search (1962 to March 2004). Seven studies were included in the analysis. Medication-related problems were categorized into the following 9 categories: indication without drug therapy, drug without indication, improper drug selection, subtherapeutic dosage, overdosage, adverse drug reaction, drug interaction, failure to receive drug, and inappropriate laboratory monitoring. A medication-related problem appearance rate was determined. We identified 1,593 medication-related problems in 395 patients (51.2% men; age, 52.4 +/- 8.2 years; 42.7% with diabetes). The most common medication-related problems found were inappropriate laboratory monitoring (23.5%) and indication without drug therapy (16.9%). Dosing errors accounted for 20.4% of medication-related problems (subtherapeutic dosage, 11.2%; overdosage, 9.2%). The medication-related problem appearance rate was 5.75e(-0.37x), where x equals number of months of follow-up (P = 0.02). HD patients experience ongoing medication-related problems. Reduction in medication-related problems in dialysis patients may improve quality of life and result in decreased morbidity and mortality. Pharmacists are uniquely trained to detect and manage medication-related problems. Pharmacists should be an integral member of the dialysis health care team.

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