Factors Associated With Medication-Related Problems in Ambulatory Hemodialysis Patients HaroldJ.Manley,PharmD,MarcyL.McClaran,RN,DebraK.Overbay,PharmD, MarciaA.Wright,PharmD,GeraldM.Reid,MD,WalterL.Bender,MD,TimothyK.Neufeld,MD, SudarshanHebbar,MD,andRichardS.Muther,MD ● Background: Hemodialysis (HD) patients are at risk for medication-related problems. Patient characteristics associated with the number of medication-related problems in HD patients have not been investigated. Methods: Patientrecordswerereviewedtoidentifymedicalproblems,prescribedmedications,medicationindication(s),and medication-related problems. Medication classes and medication-related problems were compared between pa- tients with and without diabetes mellitus (DM). Correlations were performed to determine whether associations existbetweenmedication-relatedproblems,numberofmedications,numberofmedicationdosesperday,number of comorbid conditions, patient age, and duration of end-stage renal disease while controlling for DM status. Results: Medicalrecordsof133patientswereevaluated.Patientswere60.5  15.2yearsold,prescribed11.0  4.2 medications, and had 6.0  2.3 comorbidities. Medication-related problems were identified in 97.7% of patients. Four hundred seventy-five medication-related problems were identified, averaging 3.6  1.8 medication-related problemsperpatient.PatientswithDMhadmoremedication-relatedproblemsidentifiedthanthosewithoutDM(303 versus172medication-relatedproblems,respectively; P < 0.05).Medication-relatedproblemscorrelatedpositively withnumberofpatientcomorbidities(P < 0.001). Conclusion: Medication-relatedproblemsareprevalentinvirtually all HD patients. The number of medication-related problems in an individual patient increases as the number of comorbid conditions increases. The most frequent medication-related problems were drug without indication (30.9%),laboratory(27.6%),indicationwithoutdruguse(17.5%),anddosingerrors(15.4%).PatientswithDMareat increasedriskformedication-relatedproblems.HealthcareproviderstakingcareofHDpatientsshouldbeawareof thisproblem,andeffortstoavoidorresolvemedication-relatedproblemsshouldbeundertakenatallHDclinics. Am JKidneyDis 41:386-393. © 2003bytheNationalKidneyFoundation,Inc. INDEXWORDS:Hemodialysis(HD);medication-relatedproblem;riskfactor. I N THE UNITED STATES, health care system medication-related problems cause signifi- cant morbidity, mortality, and cost. Medication- related problems are implicated in 16.1% of all hospital admissions to an internal medicine ward. 1 Of these, 58.9% of admissions could definitely or possibly be avoided. Once admitted to the hospital, greater than 18% of patient deaths in the internal medicine ward can be attributed to one or more drugs, 2 and adverse drug events contribute to more than 100,000 deaths annu- ally. 3 The cost of medication-related problems on the health care system is estimated to be in excess of $177 billion. 4 Since the release of the Institutes of Medicine report highlighting the burden of medication errors in the United States, issues of patient safety have become a priority on the health care agenda. 5 Medication-related problems can be classified into eight general categories: untreated indica- tion (IWD), improper drug selection (WD), sub- therapeutic dosage (UD), overdose (OD), ad- verse drug reaction (ADR), drug interaction (DI), failure to receive drug (FRD), and drug use without indication (DWI). 6 At an ambulatory clinic, risk factors for adverse drug events were the following indicators: more than three concur- rent disease states present, medication regimen changed four or more times during the past 12 months, five or more medications in present drug regimen, 12 or more medication doses per day, history of noncompliance, and presence of drugs that require therapeutic monitoring. 7 Risk in- creased with more risk factors present. In another study of critical care patients, impaired renal function was a risk for adverse drug outcome. 8 Currently, there are approximately 350,000 patients with end-stage renal disease (ESRD) in From the University of Missouri-Kansas City, School of Pharmacy; Dialysis Clinic, Inc; Pfizer Clinical Education Department; and Kidney Associates of Kansas City, Kansas City, MO. Received June 17, 2002; accepted in revised form August 14, 2002. Address reprint requests to Harold J. Manley, PharmD, Assistant Professor of Pharmacy Practice, University of Missouri-Kansas City, 2411 Holmes M3-C19, Kansas City, MO 64108. E-mail: manleyh@umkc.edu © 2003 by the National Kidney Foundation, Inc. 0272-6386/03/4102-0014$35.00/0 doi:10.1053/ajkd.2003.50048 American Journal of Kidney Diseases, Vol41,No2(February),2003:pp386-393 386