Dosage adjustment in renal insufficiency: comparison between databases

Abstract

Objective: To compare the information provided by three databases regarding dosage adjustment in renal failure of standardized drugs in a Brazilian teaching hospital in the Midwest region. Method: This is a documentary, descriptive and analytical study with a qualitative approach based on the analysis of information on standardized drugs in that hospital. The main variables collected were: whether the medication requires dose adjustment based on renal function, whether it is dialyzable or not. Agreement between databases was analyzed by calculating Cohen’s kappa (k) coefficient, which measures agreement between two observers. The agreement regarding the information on whether there was a dosage adjustment and whether the drug would be removed during hemodialysis was evaluated. Results: A total of 262 drugs were included (81.9% of the standardized in the institution). UpToDate® presented information for a greater number of medications, 228 medications (87%) for renal adjustment and 185 medications (70.6%) for behavior during dialysis. Micromedex® was the basis with information for the smallest quantity of drugs. Regarding the comparison between the databases regarding dosage adjustment, a moderate agreement was observed between UptoDate® and Micromedex® (k=0.474) and a fair agreement between UpToDate® and Whitebook® (k=0.379). In the comparative analysis regarding the behavior of drugs during dialysis, both UpToDate® and Micromedex® and UpToDate® and Whitebook® showed slight agreement (k=0.188 and k=0.187, respectively). Conclusion: This study found variability between the UpToDate®, Micromedex® and Whitebook® databases regarding information on dosage adjustment in renal failure and suggests considering more than one source for clinical decision-making.