Drug-Related Problems in the End-Stage Renal Disease Population

Darren W. Grabe, PharmD


October 23, 2000

In This Article

Abstract and Introduction

Drug-related problems can result in an increase in hospital admissions as well as an increase in morbidity and mortality.[1,2] As defined,[3] drug-related problems include the following categories:

  • medical indication for drug therapy but no drug;

  • wrong drug being used;

  • suboptimal dose of correct drug;

  • too much of correct drug (overdose or accumulation);

  • adverse drug reactions;

  • drug interactions (drug-drug, drug-food, and drug-laboratory);

  • patient not receiving drug (eg, nonadherence); or

  • no medical indication for drug therapy (eg, unnecessary drug therapy).

It has been estimated that drug-related morbidity and mortality costs the United States approximately $76.6 billion per year.


In fact, the issue of medication-related errors has been a recent focus of an Institute of Medicine report.


It is expected that the pharmacist will play a key role in an attempt to reduce medication-related errors and their associated costs.

The provision of clinical pharmacy services in both acute care hospitals and outpatient ambulatory clinics has been reported to reduce not only costs of therapy but also morbidity and mortality.[6,7,8] Clinical pharmacy services have been evaluated in a number of settings in an attempt to document their cost-effectiveness in providing pharmaceutical care.[9,10,11,12,13] To appropriately identify patients at risk for drug-related problems, risk factors for drug-related problems have been characterized.[14] These risk factors include 5 or more prescribed medications, 12 or more drug doses daily, 4 or more changes in the drug regimen during the last 12 months, the presence of more than 3 concurrent disease states, a history of nonadherence, and the presence of drugs that require therapeutic monitoring.


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