Umfrage zur Arzneimitteldosierung bei Niereninsuffi zienz unter nephrologisch tätigen Ärzten

Objective: Our intention was to assess knowledge and requirements related to drug dose adjustment in patients with impaired kidney function. Method: In 2005, we sent a questionnaire containing 22 questions to nephrologists in Germany and Austria. With 77 responses, the study was not representative. However, it was probably of importance for the target group of practising physicians and potential users of a future drug information system. Results: Only 28% of the responding colleagues use the package inserts; these are obviously not considered to be an obligatory guideline for dose adjustment. Th e most common dosing problems (p < 0.05) were associated with anti-infective (48%) and anti-cancer drugs (25%). Th e greatest problems with dosing were encountered within intensive care units (29%). Th e risk of excessive dosing is estimated signifi cantly more serious than the risk of underdosing (51% vs. 23%, p = 0.02). Th ere was support for the statement that for cephalosporin antibiotics the trough levels are more important than peak levels (58% vs. 27%, p < 0.01). However, only 8% knew that in patients with impaired kidney function, trough concentrations of aminoglycosides and vancomycin need to be higher than in patients with normal kidney function for adequate peak levels to be obtained. Forty-fi ve percent of respondents erroneously presumed that ceftriaxone must be adjusted to the kidney function. Half of the respondents were incorrect in assuming that ceftriaxone or moxifl oxacin would be removed by dialysis. Conclusions: We see the need for more knowledgebased information on drug dosing in patients with kidney impairment and those in the intensive care unit. Th e risk to life posed by underdosage might be underestimated, especially for anti-infective drugs.