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Ensuring safe drug administration to pediatric patients with renal dysfunction: a multicenter study

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Abstract

Background

In pediatric patients, due to variations in baseline serum creatinine (Cr) reference values, renal dysfunctions sometimes go unnoticed. In addition, renally excreted drugs need dose adjustment while nephrotoxic drugs should be avoided altogether in patients with impaired renal function. However, most physicians are apparently unaware of these facts and may administer these drugs to vulnerable patients.

Methods

We administered a questionnaire to all physicians and pharmacists specializing in pediatric medical care at six Tokyo metropolitan government-run hospitals in Japan.

Results

276 (59%) of 470 physicians and pharmacists participated. The rate of correct answers given by physicians who were asked to state the serum Cr reference range for 4-year-olds and 8-year-olds was 83 and 74%, respectively. On the other hand, the rate of correct answers given by pharmacists to the same question was only 27 and 24%, respectively. Only about 50% of physicians were aware that histamine H2-receptor antagonists and oseltamivir are renally excreted or that acyclovir and angiotensin II receptor blocker are nephrotoxic. However, most of the pharmacists recognized that histamine H2-receptor antagonists and oseltamivir are renally excreted drugs.

Conclusions

For the majority of the investigated drugs, the awareness that we need to reduce dosages for patients with renal dysfunction was insufficient. To ensure safe drug administration, communication between physicians and pharmacists is paramount. There is an urgent need for the creation of a safe drug administration protocol for pediatric patients with renal dysfunction.

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Acknowledgements

We wish to express our deep gratitude to Mr. Seiji Uchikawa of the Tokyo Metropolitan Children’s Medical Center Department of Pharmacology as well as Ms. Masako Tomotsune of the Medical Center’s Clinical Research Support Center for providing advice and guidance from the planning stages of this study. We also wish to thank Tokyo Pediatric Clinical Research Network for the support. The authors wish to thank Mr. James R. Valera, an employee of Tokyo Metropolitan Children’s Medical Center, for providing editorial support in the preparation of this manuscript.

Funding

This survey was performed using research funds provided by the 2013 Tokyo Metropolitan Hospitals’ Clinical Research Fund (Special Research) and the Health and Labour Sciences Research Grants (Clinical Trial on Development of New Drugs and Medical Devices).

Author information

Authors and Affiliations

  1. Department of Nephrology, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan

    Ryoko Harada, Kenji Ishikura, Shunsuke Shinozuka, Naoaki Mikami, Riku Hamada, Hiroshi Hataya & Masataka Honda

  2. Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan

    Kenji Ishikura

  3. Clinical Research Support Center, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan

    Yoshihiko Morikawa & Tetsuji Kaneko

  4. Department of Pediatrics, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

    Tae Omori

  5. Department of Pediatrics, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan

    Hirotaka Takahashi

  6. Department of Pediatrics, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled, Tokyo, Japan

    Hirotaka Takahashi

  7. Department of Pediatric Nephrology, Toho University Faculty of Medicine, Tokyo, Japan

    Yuko Hamasaki

  8. Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan

    Kazumoto Iijima

Authors
  1. Ryoko Harada
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  12. Kazumoto Iijima
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  13. Masataka Honda
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Corresponding author

Correspondence to Kenji Ishikura.

Ethics declarations

Conflict of interest

Kazumoto Iijima has received grants from Daiichi Sankyo Co. Ltd.

Ethical approval

All of the researchers in this study complied with the Helsinki Declaration and the Ethical Guidelines for Epidemiological Studies issued by the Ministry of Health, Labour and Welfare of Japan. With regard to informed consent, explanatory documents were attached to each questionnaire, and the act of mailing back the questionnaires was regarded as an indication of the subjects’ willingness to participate in the survey. We fully protected any personal information by not collecting the subjects’ name, initials, or age. The data obtained were anonymized. Prior to implementation, the study received approval (H25-34) from the ethics committee of Tokyo Metropolitan Children’s Medical Center, this study’s sponsoring institution.

Informed consent

With regard to informed consent, explanatory documents were attached to each questionnaire, and the act of mailing back the questionnaires was regarded as an indication of the subjects’ willingness to participate in the survey.

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Harada, R., Ishikura, K., Shinozuka, S. et al. Ensuring safe drug administration to pediatric patients with renal dysfunction: a multicenter study. Clin Exp Nephrol 22, 938–946 (2018). https://doi.org/10.1007/s10157-018-1537-7

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  • DOI: https://doi.org/10.1007/s10157-018-1537-7

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