Drug-related problems (DRPs) in children with kidney disease

Introduction Medicines are used with the intention of benefitting from their effect. The effects of medicines can also be undesirable and potentially lead to harm. A drug-related problem (DRP) is a term used to describe problem(s) that exist in the use of medicines. There remains a distinct paucity of data on the epidemiology of DRPs in children with kidney disease. Aim To investigate the epidemiology of DRPs in children with kidney disease in clinical practice at tertiary Paediatric Nephrology units. Methods Study 1: Prospective observational study on the characteristics of DRPs in hospitalised children with kidney disease. Study 2: Randomised control trial on clinical pharmacist (CP) interventions in resolving DRPs on the renal outpatient clinic. Results Study 1: A total of 127 patients were recruited and a total of 203 DRPs were identified. The incidence of DRP was 51.2% (95% CI 43.2-60.6%) of patients reviewed by the CPs. The number of medicines prescribed per child was the only significant risk factor for the occurrence of DRPs (OR 1.06, 95% CI 1.02-1.10, p = 0.002). The majority of DRPs were minor in clinical significance (68%, n = 138/203). The predominant DRPs were sub-optimal drug effect. These DRPs were associated with drug selections and dosage errors. study 2: A total of 100 patients were recruited (Control n = 53, Intervention n=47). The trial showed no effect of intervention in the resolution of active DRPs (p = 0.96) between the Control and Intervention arms. Conclusion DRPs are common in children with kidney disease and necessitate a comprehensive approach to their identification and resolution. Their characteristics in both settings are different even though the majority of them shared a similar level of clinical significance. Further research is required to evaluate the effectiveness of pharmacists' intervention in resolving DRPs at the outpatient clinics.