Pharmacist Mediated Drug Dosage Adjustment in Patients with Renal Impairment: A Prospective Interventional Study
Authors: Syed Zia Inamdar, Inamul Hoque, Sushil Kumar Londhe, Sandeep Patil, Bentoor Sanjeev, Siddanagouda Biradar, Ramakanth Baloorkar, Santosh Patil
Indian Journal of Pharmacy Practice, Vol. 19, Issue 3, pp. 367-373, (2026)
Abstract
Background: Chronic Kidney Disease (CKD) is an increasing global health challenge that significantly influences drug pharmacokinetics and pharmacodynamics. Impaired renal function reduces drug clearance, raising the likelihood of adverse drug reactions when dosages are not appropriately adjusted. Objectives: To assess the effectiveness of pharmacist-led interventions in detecting and correcting inappropriate drug dosages among patients with renal impairment in a tertiary care hospital. Materials and Methods: A prospective interventional study was carried out in the medicine, surgery, nephrology, and urology wards of a tertiary healthcare centre in Vijayapura, Karnataka. Data from 160 patients with renal impairment were collected. Estimated Glomerular Filtration Rate (eGFR) was calculated using the Cockcroft-Gault equation via Micromedex®”, and dose appropriateness was evaluated using standard renal dose-adjustment guidelines. Pharmacist recommendations were communicated to physicians, and acceptance of interventions was documented. Results: Of the 160 patients, 115 were male and 45 female, with most aged 51-60 years. A total of 1460 medications were prescribed; 470 (32.2%) required renal dose adjustment. Of these, 171 (36.4%) were appropriately modified following pharmacist intervention, whereas 299 (63.6%) remained unadjusted. Antibiotics, diuretics, and cardiovascular drugs were the most frequently affected therapeutic classes. Commonly adjusted medications included meropenem, furosemide, cefotaxime, vancomycin, fluconazole, and atenolol. Hypertension and diabetes were the most prevalent comorbidities. Conclusion: Pharmacist-led review significantly improved recognition and correction of renal dosage errors. Nonetheless, the high proportion of unadjusted medications underscores the need for stronger pharmacist-physician collaboration and routine renal-dose monitoring to minimize toxicity and enhance clinical outcomes.
Keywords: Chronic kidney disease, Dose adjustment, Drug monitoring, Medication safety, Pharmacist intervention, Renal impairment
