대한신장학회

논문분류	춘계학술대회 초록집
제목	Drug-Related Problems in Hospitalized Patients With Kidney Disease and the Role of Clinical Pharmacists
저자	Hee Jung Ha
출판정보	2025; 2025(1):
키워드	Kidney disease, Drug-related problems, Hospitalized patients, Clinical pharmacist, Pharmaceutical care service
초록	Patients with kidney disease are at a high risk of drug-related problems (DRPs) due to polypharmacy and altered pharmacokinetics. This study aims to characterize DRPs in hospitalized patients with kidney disease at a tertiary care hospital and evaluate the impact of clinical pharmacist interventions. Patients admitted to the nephrology ward of a tertiary care hospital between 2021 and 2023 who received pharmacist-led clinical services were included in this study. These services encompassed medication reconciliation (MR), medication evaluation and management (MEM), and pharmaceutical care transition, during which DRPs were identified and interventions performed. DRPs were classified using the Pharmaceutical Care Network Europe classification (version 9.1) and analyzed via network analysis. Statistical analyses were conducted using R (version 4.4.3) Between January 2021 and December 2023, clinical pharmacists conducted 781 drug-related interventions in 2,034 patients (mean age, 52.5 years; median eGFR, 9.2 mL/min/1.73 m²). Among the 914 MEM-related DRPs identified, the most frequently involved drug classes were those used for chronic kidney disease (CKD)-mineral and bone disorder (MBD) (10.6%), anemia (8.9%), gastrointestinal diseases (6.0%), and infections (4.4%). For the 405 MR-related DRPs, the most commonly implicated drug classes were those for dyslipidemia (14.8%), hypertension (14.8%), CKD-MBD (8.9%), and gastrointestinal diseases (7.7%). The most frequent DRP type was 'P1.3 Untreated symptoms or indication' (29.6%), while the primary cause was 'C1.6 Contraindicated drug prescribed/used' (22.1%). DRPs predominantly involved medications requiring electrolyte correction and renal dose adjustments. A total of 80.7% of pharmaceutical intervention recommendations were accepted, and 75.7% of DRPs were resolved after intervention by the clinical pharmacist. These findings highlight the need for careful serum electrolyte monitoring and dose individualization in nephrology inpatients. Clinical pharmacists play a critical role in mitigating DRPs, optimizing pharmacotherapy, and preventing medication discrepancies at admission and discharge in patients with kidney disease.
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