{"id":117175,"date":"2018-03-11T10:46:37","date_gmt":"2018-03-11T10:46:37","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/efectividad-de-un-programa-de-intervencion-para-prevenir-el-dano-renal-mediante-el-ajuste-de-dosis-de-farmacos-potencialmente-nefrotoxicos-en-pacientes-con-enfermedad-renal-cronica\/"},"modified":"2018-03-11T10:46:37","modified_gmt":"2018-03-11T10:46:37","slug":"efectividad-de-un-programa-de-intervencion-para-prevenir-el-dano-renal-mediante-el-ajuste-de-dosis-de-farmacos-potencialmente-nefrotoxicos-en-pacientes-con-enfermedad-renal-cronica","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/farmacologia\/efectividad-de-un-programa-de-intervencion-para-prevenir-el-dano-renal-mediante-el-ajuste-de-dosis-de-farmacos-potencialmente-nefrotoxicos-en-pacientes-con-enfermedad-renal-cronica\/","title":{"rendered":"Efectividad de un programa de intervenci\u00f3n para prevenir el da\u00f1o renal mediante el ajuste de dosis de f\u00e1rmacos potencialmente nefrot\u00f3xicos en pacientes con enfermedad renal cr\u00f3nica."},"content":{"rendered":"<h2>Tesis doctoral de <strong> Aurelio Cabello Muriel <\/strong><\/h2>\n<p>Objetivos objetivo general: evaluar la efectividad de un programa de intervenci\u00f3n entre el m\u00e9dico y farmac\u00e9utico para prevenir el da\u00f1o renal, mediante el ajuste de la pauta posol\u00f3gica de f\u00e1rmacos potencialmente nefrot\u00f3xicos en pacientes con erc que ingresan en el servicio de medicina interna del hospital general universitario reina sof\u00eda de murcia. objetivos espec\u00edficos: determinar la preValencia de la poblaci\u00f3n de pacientes con erc y analizar su perfil cl\u00ednico y farmacoterap\u00e9utico. Conocer el manejo de la prescripci\u00f3n de f\u00e1rmacos nefrot\u00f3xicos. Identificar los factores asociados a una posible dosificaci\u00f3n inadecuada. Comparar la evoluci\u00f3n de la funci\u00f3n renal de los pacientes que participan en el programa de intervenci\u00f3n frente a aquellos que no participan. Evaluar si las recomendaciones realizadas dentro del programa de intervenci\u00f3n tienen una repercusi\u00f3n negativa que afecte al objetivo terap\u00e9utico del tratamiento. Evaluar la concordancia en la estimaci\u00f3n de la filtraci\u00f3n glomerular al utilizar diferentes f\u00f3rmulas y su repercusi\u00f3n en el estadiaje de los pacientes y las consiguientes recomendaciones de ajuste posol\u00f3gico. material y m\u00e9todo estudio prospectivo, abierto, cuasi-experimental, controlado y de grupos paralelos. El estudio se realiz\u00f3 en el hospital general universitario reina sof\u00eda de murcia, hospital de referencia del \u00e1rea vii de la regi\u00f3n de murcia, dotado de 330 camas de hospitalizaci\u00f3n.  los pacientes con erc que ingresaban en el servicio de medicina interna se asignaban al grupo control o grupo de intervenci\u00f3n dependiendo del ala del hospital donde ingresasen. A los pacientes del grupo control se le midi\u00f3 la filtraci\u00f3n glomerular al ingreso y al alta, se anot\u00f3 el tratamiento que ten\u00eda al ingreso y se procedi\u00f3 con la pr\u00e1ctica cl\u00ednica habitual. Para los pacientes incluidos en el grupo de intervenci\u00f3n, adem\u00e1s de medir la filtraci\u00f3n glomerular al ingreso y al alta, y recoger su historia farmacoterap\u00e9utica, se le hizo una entrevista estructurada al paciente o cuidador, por parte del farmac\u00e9utico para asegurar recoger toda la medicaci\u00f3n que el paciente estaba tomando. Tras su evaluaci\u00f3n, el farmac\u00e9utico realizaba una recomendaci\u00f3n de ajuste posol\u00f3gico para aquellos f\u00e1rmacos con una potencial nefrotoxicidad descrita, que no estaban adecuadamente ajustados a la funci\u00f3n renal del paciente en un periodo de 24-48h tras el ingreso. Se consider\u00f3 que la recomendaci\u00f3n era aceptada si se produc\u00eda la modificaci\u00f3n en las siguientes 24h tras su realizaci\u00f3n. Diariamente se hac\u00eda un seguimiento de la funci\u00f3n renal de los pacientes incluidos en el grupo de intervenci\u00f3n, por si hubiese variaciones que afectasen a la dosificaci\u00f3n del tratamiento vigente.  finalmente se analizaron las diferencias que se encontrar\u00edan en cuanto al estadiaje de los pacientes con enfermedad renal si se utiliza la f\u00f3rmula de cockroft-gault o mdrd4, y en qu\u00e9 medida estas diferencias afectar\u00edan a la recomendaci\u00f3n de ajuste posol\u00f3gico realizadas. resultados \tel 80% de los pacientes con erc que ingresaron en el servicio de medicina interna ten\u00edan alg\u00fan f\u00e1rmaco nefrot\u00f3xico en su tratamiento, y el 51% tiene al menos una prescripci\u00f3n de estos f\u00e1rmacos no ajustada a la funci\u00f3n renal del paciente. La relaci\u00f3n de f\u00e1rmacos nefrot\u00f3xicos por paciente fue de 1,7\u00c2\u00b10,9 en el hospital y 0,7\u00c2\u00b10,4 en la medicaci\u00f3n domiciliaria.\t en el programa de intervenci\u00f3n se incluyeron a 249 pacientes, 124 en el grupo control y 125 en el grupo de intervenci\u00f3n. Se recogieron 329 prescripciones diferentes de f\u00e1rmacos potencialmente nefrot\u00f3xicos, de las cuales 88 no estaban ajustadas a la funci\u00f3n renal del paciente. El porcentaje de aceptaci\u00f3n de las recomendaciones fue del 73,9%. Encontramos significaci\u00f3n estad\u00edstica, en el an\u00e1lisis de las diferencias ajustado de cr y clcr relativa al ingreso y al alta, entre los grupos control e intervenci\u00f3n, (diferencias ajustadas crcl relativa  entre grupo control-grupo intervenci\u00f3n: 19,9 (1,2 &#8211; 38,5, ic 95%)). en 166 pacientes el estadiaje de la enfermedad cambiar\u00eda si se utilizase la f\u00f3rmula de cg o mdrd4. De las 222 prescripciones de f\u00e1rmacos potencialmente nefrot\u00f3xicos realizadas a los pacientes cuyo estad\u00edo de la enfermedad var\u00eda al utilizar la f\u00f3rmula de cg o mdrd4, 145 ver\u00edan modificada su recomendaci\u00f3n posol\u00f3gica. conclusiones \tla preValencia de pacientes con f\u00e1rmacos potencialmente nefrot\u00f3xicos que ingresan en el servicio de medicina interna es alta. La exposici\u00f3n a f\u00e1rmacos nefrot\u00f3xicos es notablemente mayor en el medio hospitalario. Un elevado porcentaje no est\u00e1n ajustados de acuerdo a la funci\u00f3n renal del paciente. El programa de intervenci\u00f3n ha mostrado un beneficio en cuanto a la evoluci\u00f3n de la funci\u00f3n renal de los pacientes con erc. La aceptaci\u00f3n de las recomendaciones realizadas no ha comprometido el \u00e9xito terap\u00e9utico del tratamiento. Utilizar una ecuaci\u00f3n u otra para estimar fg tiene una elevada influencia en la recomendaci\u00f3n de ajuste posol\u00f3gico que se realiza, por lo que existe un riesgo real de sobredosificar o infradosificar al paciente si no se utiliza la f\u00f3rmula adecuada. abstract objectives main objective: evaluate the effectiveness of an intervention program between the doctor and pharmacist to prevent kidney damage, by adjusting the dose regimen of potentially nephrotoxic drugs in patients with ckd admitted to the internal medicine department of hospital general universitario reina sof\u00eda de murcia. specific objectives: to determine the prevalence of the population of patients with ckd and analyze clinical and pharmacotherapeutic profile. Meet management prescribing nephrotoxic drugs. Identify factors associated with inadequate dosage possible. To compare the evolution of renal function of patients participating in the intervention program compared to those who do not. To assess whether the recommendations made within the intervention program impact negatively affecting the therapeutic goal of treatment. To assess the concordance in estimated glomerular filtration rate using different formulas and their impact on the staging of patients and subsequent dose adjustment recommendations. materials and methods prospective, open, quasi-experimental, controlled, parallel group study. Study the study was conducted at the hospital general universitario reina sof\u00eda de murcia, hospital referral area vii of the region of murcia, with 330 inpatient beds. depending on the section of the hospital to which these patients were admitted, the patients were assigned to either a control group, in which renal function at the time of admission and discharge was measured, or an intervention group; in this latter group, in addition to measuring kidney function at the time of admission and at discharge, the subjects were followed daily and dose adjustment recommendations were made in cases where nephrotoxic drugs were not properly adjusted.  finally, grading of the disease for patients and dose adjustment recommendations of potentially nephrotoxic drugs was compared using the cockroft-gault or mdrd4 formula. result 80% of ckd patients admitted to the internal medicine service had a nephrotoxic drug treatment, and 51% have at least one prescription of these drugs is not adjusted for renal function. The ratio of nephrotoxic drugs per patient was 1.7 \u00c2\u00b1 0.9 in the hospital and 0.7 \u00c2\u00b1 0.4 in home medication. a total of 249 patients were included in the intervention program, 124 in the control group and 125 in the intervention group. 329 different prescription of potentially nephrotoxic drugs were collected, of which 88 were not adjusted for renal function. The rate of acceptance of the recommendations was 73.9%. We found statistically significant in the adjusted analysis of cr and crcl differences on admission and at discharge, between control and intervention groups (adjusted relative crcl between the control-group differences intervention group: 19.9 (1.2 to 38.5, 95%)). in 166 patients the staging of the disease change if mdrd4 or cg formula was used. Of the 222 prescriptions of potentially nephrotoxic drugs, 145 dosage adjustment recommendations would have differed. conclusions the prevalence of patients with potentially nephrotoxic drugs in internal medicine is high. Exposure to nephrotoxic drugs is significantly higher in hospitals than in the house. A large percentage are not adjusted according to renal function. The intervention program has shown a benefit in terms of the evolution of renal function in patients with ckd. The acceptance of the recommendations has not compromised the therapeutic treatment success. Use an equation to estimate gfr or another has a significant influence on the recommendation of dosage adjustment is performed, so there is a real risk of overdosing or infradosificar the patient if the right formula is not used.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Efectividad de un programa de intervenci\u00f3n para prevenir el da\u00f1o renal mediante el ajuste de dosis de f\u00e1rmacos potencialmente nefrot\u00f3xicos en pacientes con enfermedad renal cr\u00f3nica.<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Efectividad de un programa de intervenci\u00f3n para prevenir el da\u00f1o renal mediante el ajuste de dosis de f\u00e1rmacos potencialmente nefrot\u00f3xicos en pacientes con enfermedad renal cr\u00f3nica. <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Aurelio Cabello Muriel <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 20\/02\/2015<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Carles Iniesta Navalon<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: Juan  enrique Pere\u00f1iguez barranco <\/li>\n<li>Jaime eduardo Poquet jornet (vocal)<\/li>\n<li>enrique Bernal morell (vocal)<\/li>\n<li>Jos\u00e9 vicente Tuells hern\u00e1ndez (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Aurelio Cabello Muriel Objetivos objetivo general: evaluar la efectividad de un programa de intervenci\u00f3n entre el m\u00e9dico 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