Renal Drug Dosage Adjustment According to Estimated Creatinine Clearance in Hospitalized Patients With Heart Failure Gokhan Altunbas, MD, 1 * Mehmet Yazıcı, MD, 1 Yalcin Solak, MD, 2 Enes E. Gul, MD, 1 Mehmet Kayrak, MD, 1 Zeynettin Kaya, MD, 1 Hakan Akilli, MD, 1 Alpay Aribas, MD, 1 Abduzhappar Gaipov, MD, 2 Raziye Yazıcı, MD, 3 and Kurtulus Ozdemir, MD 1 It is of clinical importance to determine creatinine clearance and adjust doses of prescribed drugs accordingly in patients with heart failure to prevent untoward effects. There is a scarcity of studies in the literature investigating this issue particularly in patients with heart failure, in whom many have impaired kidney function. The purpose of this study was to determine the degree of awareness of medication prescription as to creatinine clearance in patients hospitalized with heart failure. Patients hospitalized with a diagnosis of heart failure were retrospectively evaluated. Among screened charts, patients with left ventricular ejection fraction ,40% and an estimated glomerular filtration rate (eGFR) of #50 mL/min were included in the analysis. The medications and respective doses pre- scribed at discharge were recorded. Medications requiring renal dose adjustment were determined and evaluated for appropriate dosing according to eGFR. A total of 388 patients with concomitant heart failure and renal dysfunction were included in the study. The total number of prescribed medications was 2808 and 48.3% (1357 medications) required renal dose adjustment. Of the 1357 medications, 12.6% (171 medications) were found to be inappropriately prescribed according to eGFR. The most common inappropriately prescribed medications were famotidine, metformin, peri- ndopril, and ramipril. A significant portion of medications used in heart failure requires dose adjust- ment. Our results showed that in a typical cohort of patients with heart failure, many drugs are prescribed at inappropriately high doses according to creatinine clearance. Awareness should be increased among physicians caring for patients with heart failure to prevent adverse events related to medications. Keywords: renal dose adjustment, heart failure, renal failure, polypharmacy INTRODUCTION Renal dysfunction frequently accompanies heart failure. In a systematic review by Smith et al, 1 the frequency of any renal impairment was 63% and the frequency of moderate to severe renal impairment was 29% in pa- tients with congestive heart failure. Recently, Wong et al 2 found that the proportion of patients with heart failure who were older than 80 years increased from 13.3% in 1988–1994 to 22.4% in 2003–2008. The propor- tion of patients who had 5 or more comorbid chronic conditions increased from 42.1% to 58.0% during these Departments of 1 Cardiology and 2 Nephrology, Konya Necmettin Erbakan University, Meram School of Medicine, Meram, Konya, Turkey; and 3 Department of Nephrology, Konya Teaching and Research Hospital, Konya, Turkey. Dr. A. Gaipov received grant support from the ERA-EDTA fellow- ship program. The authors have no conflicts of interest to declare. *Address for correspondence: Department of Cardiology, Kilis State Hospital, Kilis 79000, Turkey. E-mail: drgokhanaltun@gmail.com American Journal of Therapeutics 0, 000–000 (2013) 1075–2765 Ó 2013 Lippincott Williams & Wilkins www.americantherapeutics.com Copyright ª Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.