Seguimiento farmacoterapéutico de personas con enfermedad renal crónica estadio 5 en tratamiento renal sustitutivo: impacto clínico y humanístico
Fecha
2024
Tipo
tesis doctoral
Autores
Pereira Céspedes, Alfonso
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Resumen
Introducción: Los pacientes con enfermedad renal crónica (ERC) en tratamiento renal sustitutivo (TRS) presentan un deterioro de la calidad de vida relacionada con salud (CVRS), pluripatología y un régimen terapéutico complejo lo que aumenta el riesgo de presentar resultados negativos asociados a la medicación (RNM) y problemas relacionados con medicamentos (PRM). El objetivo del estudio fue evaluar el impacto clínico y humanístico del servicio de seguimiento farmacoterapéutico, en personas con ERC estadio 5 en TRS, con el fin de que se maximicen la efectividad y seguridad de la farmacoterapia, minimizando los riesgos asociados al uso de medicamentos. Materiales y método: Estudio observacional, descriptivo, prospectivo. Se incluyeron pacientes mayores de 18 años con ERC estadio 5 y en TRS (hemodiálisis, diálisis peritoneal y trasplante renal) que fueron atendidos en el Servicio de Nefrología del Hospital Universitario Virgen de las Nieves (Granada, España). Los datos se recolectaron entre febrero de 2021 y julio de 2023 mediante utilización del cuestionario KDQOL-SF para la evaluación de CVRS, registros electrónicos (historias clínicas y analíticas), entrevistas semiestructuradas y conversaciones con nefrólogos. Los RNM/PRM se identificaron mediante una adaptación del Método Dáder al ámbito hospitalario. La regresión logística binaria determinó los factores asociados (p< 0,05). Resultados: Se incluyeron 117 pacientes, de los cuales 62 (52,99%) eran hombres. La edad media era 63 (DT:14) años, con 72 (61,54%) en hemodiálisis, 29 (24,79%) en trasplante renal y 16 (13,68%) en diálisis peritoneal. Se identificaron 2436 RNM y 3303 PRM, con una tasa de 20,82 RNM y 28,23 PRM por paciente. Los RNM predominantes incluyeron: problema de salud insuficientemente tratado (58,95%), inefectividad cuantitativa (35,43%), e inseguridad no cuantitativa (31,62%). Los PRM dominantes fueron: problemas de salud insuficientemente tratados (37,63%), la dosis, pauta, duración no adecuada (33,00%), la alta probabilidad de efectos adversos (16,14%) y la falta de adherencia (6,87%). Los pacientes con alta probabilidad de efectos adversos, problema de salud insuficientemente tratados y anemia se asociaron a inefectividad cuantitativa. La alta probabilidad de efectos adversos y la deficiencia/insuficiencia de vitamina D (25OH) se correlacionaron con inseguridad no cuantitativa. Los farmacéuticos realizaron intervenciones de educación a los 117 pacientes. Se destaca, una tasa de una intervención farmacéutica por paciente. En cuanto a la CVRS: se incluyeron 91 participantes, de los cuales 47 (48,35%) eran mujeres. La edad media era de 62 (DT: 13) años, con 52 (57,14%) en hemodiálisis, 13 (14,29%) en diálisis peritoneal y 26 (28,57%) en trasplante renal. El estudio reveló una puntuación media del componente físico (PCS) de 40,89 (DT: 9,02) y una puntuación del componente mental (MCS) de 47,19 (DT: 11,37). Conclusión: Los pacientes mostraron una alta tasa de RNM y PRM. Factores como alta probabilidad de efectos adversos, problema de salud insuficientemente tratados, anemia y la deficiencia/insuficiencia de vitamina D (25OH) se correlacionaron con RNM. Este estudio subraya hallazgos significativos en pacientes sometidos a TRS, indicando menores puntuaciones de MCS y PCS medidas por el cuestionario KDQOL- SF. Los factores asociados con la CVRS abarcan: la edad, el número de problemas de salud, el número de medicamentos y parámetros clínicos como los niveles de vitamina D y calcio. Se hace hincapié en la necesidad de realizar más estudios en la temática para la evaluación del SFT.
Introduction: Patients with chronic kidney disease (CKD) undergoing renal replacement therapy (RRT) commonly experience a decline in health-related quality of life (HRQoL), multifaceted health issues, and a complex medication regimen, heightening the risk of negative outcomes associated with medication (NOM) and drugrelated problems (DRP). This study aims to assess the clinical and humanistic impact of a medication review with follow-up service for individuals with stage 5 CKD receiving RRT, with the objective of optimizing the efficacy and safety of pharmacotherapy while minimizing associated risks. Methods: This observational, descriptive, prospective study enrolled patients aged 18 and above with stage 5 CKD undergoing RRT (including hemodialysis, peritoneal dialysis, and renal transplantation) at the Nephrology Department of Virgen de las Nieves University Hospital (Granada, Spain) between February 2021 and July 2023. Data collection involved the use of the KDQOL-SF questionnaire for HRQoL assessment, electronic health records, semi-structured interviews, and discussions with nephrologists. NOM and DRP were identified using an adapted version of the Dáder Method, with associated factors determined through binary logistic regression analysis (p < 0.05). Results: A total of 117 patients were included, with 62 (52.99%) being male and a mean age of 63 years (SD: 14). The distribution of patients included 72 (61.54%) on hemodialysis, 29 (24.79%) with renal transplantation, and 16 (13.68%) on peritoneal dialysis. A total of 2436 NOM and 3303 DRP were identified, with a rate of 20.82 NOM and 28.23 DRP per patient. The primary NOM included untreated conditions (58.95%), quantitative ineffectiveness (35.43%), and non-quantitative safety problems (31.62%). Dominant DRP comprised undertreated conditions (37.63%), wrong dose/posology/length (33.00%), risk of adverse drug reactions (ADR) (16.14%), and nonadherence (6.87%). Factors such as risk of adverse drug reactions, untreated conditions, anemia, and vitamin D deficiency/insufficiency (25OH) were associated with quantitative ineffectiveness. Similarly, risk of ADR and vitamin D deficiency/insufficiency (25OH) were correlated with non-quantitative safety problems. Pharmacists provided health education interventions to the 117 patients. At a rate of 1.0 pharmacist interventions per patient. Regarding HRQoL, 91 participants were assessed, with 47 (48.35%) being women and a mean age of 62 years (SD: 13). The majority were on hemodialysis 52 (57.14%), followed by renal transplantation 26 (28.57%) and peritoneal dialysis 13 (14.29%). The study revealed a mean physical component score (PCS) of 40.89 (SD: 9.02) and a mental component score (MCS) of 47.19 (SD: 11.37). Conclusion: Patients undergoing RRT exhibited a high prevalence of NOM and DRP. Factors such as risk of adverse drug reactions, untreated conditions, anemia, and vitamin D deficiency/insufficiency (25OH) were associated with NOM. Additionally, the study identified lower MCS and PCS scores on the KDQOL-SF questionnaire among patients undergoing RRT, with factors such as age, number of health problems, number of medications, and clinical parameters like vitamin D and calcium levels influencing HRQoL. Further research in this area to assess the effectiveness of medication review with follow-up service is warranted.
Introduction: Patients with chronic kidney disease (CKD) undergoing renal replacement therapy (RRT) commonly experience a decline in health-related quality of life (HRQoL), multifaceted health issues, and a complex medication regimen, heightening the risk of negative outcomes associated with medication (NOM) and drugrelated problems (DRP). This study aims to assess the clinical and humanistic impact of a medication review with follow-up service for individuals with stage 5 CKD receiving RRT, with the objective of optimizing the efficacy and safety of pharmacotherapy while minimizing associated risks. Methods: This observational, descriptive, prospective study enrolled patients aged 18 and above with stage 5 CKD undergoing RRT (including hemodialysis, peritoneal dialysis, and renal transplantation) at the Nephrology Department of Virgen de las Nieves University Hospital (Granada, Spain) between February 2021 and July 2023. Data collection involved the use of the KDQOL-SF questionnaire for HRQoL assessment, electronic health records, semi-structured interviews, and discussions with nephrologists. NOM and DRP were identified using an adapted version of the Dáder Method, with associated factors determined through binary logistic regression analysis (p < 0.05). Results: A total of 117 patients were included, with 62 (52.99%) being male and a mean age of 63 years (SD: 14). The distribution of patients included 72 (61.54%) on hemodialysis, 29 (24.79%) with renal transplantation, and 16 (13.68%) on peritoneal dialysis. A total of 2436 NOM and 3303 DRP were identified, with a rate of 20.82 NOM and 28.23 DRP per patient. The primary NOM included untreated conditions (58.95%), quantitative ineffectiveness (35.43%), and non-quantitative safety problems (31.62%). Dominant DRP comprised undertreated conditions (37.63%), wrong dose/posology/length (33.00%), risk of adverse drug reactions (ADR) (16.14%), and nonadherence (6.87%). Factors such as risk of adverse drug reactions, untreated conditions, anemia, and vitamin D deficiency/insufficiency (25OH) were associated with quantitative ineffectiveness. Similarly, risk of ADR and vitamin D deficiency/insufficiency (25OH) were correlated with non-quantitative safety problems. Pharmacists provided health education interventions to the 117 patients. At a rate of 1.0 pharmacist interventions per patient. Regarding HRQoL, 91 participants were assessed, with 47 (48.35%) being women and a mean age of 62 years (SD: 13). The majority were on hemodialysis 52 (57.14%), followed by renal transplantation 26 (28.57%) and peritoneal dialysis 13 (14.29%). The study revealed a mean physical component score (PCS) of 40.89 (SD: 9.02) and a mental component score (MCS) of 47.19 (SD: 11.37). Conclusion: Patients undergoing RRT exhibited a high prevalence of NOM and DRP. Factors such as risk of adverse drug reactions, untreated conditions, anemia, and vitamin D deficiency/insufficiency (25OH) were associated with NOM. Additionally, the study identified lower MCS and PCS scores on the KDQOL-SF questionnaire among patients undergoing RRT, with factors such as age, number of health problems, number of medications, and clinical parameters like vitamin D and calcium levels influencing HRQoL. Further research in this area to assess the effectiveness of medication review with follow-up service is warranted.
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ATENCIÓN FARMACÉUTICA, TRATAMIENTO RENAL SUSTITUTIVO, PROBLEMAS RELACIONADOS CON MEDICAMENTOS, RESULTADOS NEGATIVOS ASOCIADOS A LA MEDICACIÓN, CALIDAD DE VIDA