| Objective:To investigated the detection and awareness of chronic renal insufficiency (CRI) and related complications in hospitalization patients. To analyze the clinical use of antimicrobial agents in patients with CRI. To provide theoretic basis for improving clinical rational drug use.Methods:A total of 51,496 adult patients who were hospitalized in Qianfoshan Hospital, Shandong University from October 2013 to December 2014 were included in this study. Demographics, clinical data, and laboratory data included urinary and hematologic parameters, Clinical diagnosis and medication, etc, were collected. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) two-level race equation was used for reporting eGFR. CRI was defined as estimated GFR (eGFR) <60 ml/min per 1.73 m2, and patients with acute kidney injury were excluded. CRI was classified as 3A to 5 stages according to K/DOQI guideline and patients who were receiving dialysis were defined as stage5D.using the clinical data, to investigated and analyze the detection and awareness of CRI and related complications, and calculate the treatment percent of related complications, and analysis the antimicrobial drug use.Results:Totally 2115 cases were entered into the final analysis, the subjects comprised 55.1% men and 44% women, and the age was 68 (52-78) y. The overall prevalence of CRI was 4.1%. It was noted that there were about 64.8% CRI patients (excluded patients from nephrology department) being not diagnosed during their hospitalization and the proportion of stage 3 patients was the largest population. Among CRI patients, the prevalence of anemia, hypocalcaemia, hyperphosphatemia, and acidosis was 67.1%,26.1%,34.0% and 41.6% respectively, and the prevalence increased significantly as renal function declined in patients without receiving dialysis. The total prevalence of hypertention and hyperkalemia was 54.5% and 9.9%, respectively, and rose by CKD stage.In the total 2115 cases, there were 50.7%(1072) patients had history of anti-infective drug application during their hospitalization. Which comprised 54.2% men and 45.8% women, the median age was 69 (54-79). Among them,503 people had a kind of antibacterial drug alone,313 people with the combination of two types drug, and 256 people had the application of three or even more kinds drug. Totally, 1897 cases of antimicrobial drugs application were enrolled in the end. The total adjusted rate of antimicrobial drug doses was 27.0%(513 cases), and the unreasonable utility ratio (cases which awaited dosage adjusting but had not been adjusted or cases with antimicrobial drugs which should be used with caution) was 32.3% (495+117/1008), meanwhile, the unreasonable utility ratio of the clinical antimicrobial agents usage in patients with CRI, was respectively distributed from stage 3 A to stage 5D at the following percentage,25.6%(stage 3 A),37.5%(stage 3B), 35.1%(stage 4),40.5%(stage 5) and 33.9%(stage 5D). Results also showed that Cephalosporins was the most widely used antimicrobial agents in our hospital, with a proportion of 35.2%(668 cases), especially the third generation of cephalosporin drugs(65.0%), among all the cephalosporin antibiotics, the proportion of cases which awaited dosage adjusting but had not been adjusted was 51.6%. the second widely used antimicrobial agents was quinolone, with a proportion of 25.3%(480 cases); penicillins accounted for 13.1%(248 cases).Conclusions:1. CRI was a great burden in hospitalized patients, with a high prevelance, but the detection and awareness was still low.2. The prevalence of CRI-related complications increased significantly as renal function declined, and the rate of drug treatment also raised as the CRI worsen, but overall usage rate was still low.3. The adjusted rate of Antimicrobial drug doses was also still low, which showed that propaganda and learning about the knowledge of antibiotics remains to be intensified. |
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