Medication-related problems in ambulatory hemodialysis patients: a pooled analysis

Am J Kidney Dis. 2005 Oct;46(4):669-80. doi: 10.1053/j.ajkd.2005.07.001.


Background: Medication-related problems are common in hemodialysis (HD) patients. These patients often require 12 medications to treat 5 to 6 comorbid conditions. Medication-related problem research reports cannot be generalized to the entire HD population because data are obtained from single centers and limited numbers of patients. We conducted a pooled analysis to gain additional insight into the frequency, type, and severity of medication-related problems and extrapolated the data to the entire US HD population.

Methods: Articles were identified through a MEDLINE search (1962 to March 2004). Seven studies were included in the analysis. Medication-related problems were categorized into the following 9 categories: indication without drug therapy, drug without indication, improper drug selection, subtherapeutic dosage, overdosage, adverse drug reaction, drug interaction, failure to receive drug, and inappropriate laboratory monitoring. A medication-related problem appearance rate was determined.

Results: We identified 1,593 medication-related problems in 395 patients (51.2% men; age, 52.4 +/- 8.2 years; 42.7% with diabetes). The most common medication-related problems found were inappropriate laboratory monitoring (23.5%) and indication without drug therapy (16.9%). Dosing errors accounted for 20.4% of medication-related problems (subtherapeutic dosage, 11.2%; overdosage, 9.2%). The medication-related problem appearance rate was 5.75e(-0.37x), where x equals number of months of follow-up (P = 0.02).

Conclusion: HD patients experience ongoing medication-related problems. Reduction in medication-related problems in dialysis patients may improve quality of life and result in decreased morbidity and mortality. Pharmacists are uniquely trained to detect and manage medication-related problems. Pharmacists should be an integral member of the dialysis health care team.

Publication types

  • Meta-Analysis

MeSH terms

  • Adult
  • Aged
  • Algorithms
  • Ambulatory Care
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / drug therapy
  • Cohort Studies
  • Comorbidity
  • Drug Interactions
  • Drug-Related Side Effects and Adverse Reactions*
  • Endocrine System Diseases / complications
  • Endocrine System Diseases / drug therapy
  • Female
  • Gastrointestinal Diseases / complications
  • Gastrointestinal Diseases / drug therapy
  • Humans
  • Hyperlipidemias / complications
  • Hyperlipidemias / drug therapy
  • Infections / complications
  • Infections / drug therapy
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / drug therapy
  • Kidney Failure, Chronic / therapy
  • Male
  • Mental Disorders / complications
  • Mental Disorders / drug therapy
  • Middle Aged
  • Outpatients*
  • Pain / complications
  • Pain / drug therapy
  • Patient Care Team
  • Pharmaceutical Preparations / classification
  • Pharmacists
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Renal Dialysis*
  • Thrombosis / complications
  • Thrombosis / drug therapy
  • United States / epidemiology


  • Pharmaceutical Preparations