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Abstract：
Background and aims: Medication dosage adjustments for renally impaired patients have not been studied in Botswana. This study was conducted to determine prescribing practices among patients with renal impairment in medical wards to improve future patient care.Methods: We conducted a retrospective study involving medical charts of patients admitted at a tertiary level hospital in Gaborone Botswana. Study participants included all patients admitted between August and October 2016 who were hospitalized for ≥24 h. \'Drug prescribing in renal failure: dosing guidelines for adults and children\'. was used to determine the extent of dosage adjustments. A logistic regression model was used to assess which patient factors were associated with inappropriate dosage adjustment.Results: Twenty-nine percent (233/804) of patients had renal impairment. Of these, 184 patients with renal impairment were included in the final analysis. There were 1143 prescription entries, of which 20.5% (n = 234) required dosage adjustment for renal function but only 45.7% (n = 107) were adjusted correctly. Of note, 112 patients were prescribed at least one drug that required dosage adjustment and only 30.4% (n = 34) patients had all of their medications appropriately adjusted. Patient factors associated with inappropriate dosage adjustment included a higher number of medicines being prescribed. Mortality among patients with renal impairment was independently associated with higher scores of the Charlson comorbidity index and hospital stay duration of 1-7 days.Conclusion: The renal function status of patients was not sufficiently taken into account when prescribing medicines especially in patients with severely impaired kidney function in Botswana. Continuous medical education needs to be encouraged to address this, which is being implemented. We will be following this up in future studies.
摘要：
背景和目的：在博茨瓦纳尚未研究肾脏受损患者的药物剂量调整。进行这项研究是为了确定内科病房中肾功能损害患者的处方实践，以改善未来的患者护理。方法：我们进行了一项回顾性研究，涉及博茨瓦纳哈博罗内三级医院收治的患者的病历。研究参与者包括2016年8月至10月期间住院≥24小时的所有患者。用于确定剂量调整的程度。使用逻辑回归模型来评估哪些患者因素与不适当的剂量调整相关。结果：29％（233/804）的患者患有肾功能损害。其中,184例肾功能损害患者纳入最终分析。有1143个处方条目，其中20.5％（n=234）需要调整肾功能剂量，但只有45.7％（n=107）正确调整。值得注意的是，112名患者至少有一种药物需要调整剂量，只有30.4％（n=34）的患者对所有药物进行了适当调整。与不适当的剂量调整相关的患者因素包括处方的药物数量较多。肾功能损害患者的死亡率与Charlson合并症指数的较高评分和1-7天的住院时间独立相关。结论：在开药时，尤其是在博茨瓦纳肾功能严重受损的患者中，未充分考虑患者的肾功能状况。需要鼓励继续医学教育来解决这个问题，正在实施。我们将在未来的研究中跟进这一点。
