Drug prescribing in critically ill children with kidney impairment: Comparing clinical practice with clinical decision support recommendations.

Abstract

The kidneys play a crucial role in eliminating drugs, and their functional impairment can lead to drug accumulation and adverse effects. To prevent this, drug dosages (doses or administration intervals) are adjusted based on kidney function using the Glomerular Filtration Rate (GFR). Calculating dosages is an error prone task, particularly in paediatric patients where individual dosing strategies can be complex. This study assessed the potential application of a novel feature of the paediatric clinical decision support system (CDSS) PEDeDose that calculates adjusted drug dosages for children with impaired kidney function. Renal dosing practices in a paediatric intensive care patients with impaired kidney function were compared to recommendations provided by PEDeDose. This retrospective observational feasibility study analysed drug prescriptions in patients with impaired kidney function from electronic health records of the paediatric intensive care unit (PICU) of the University Children's Hospital Basel in 2023. Extracted data included patients' age, weight, height, and length of PICU stay, drug administration records, serum creatinine and cystatin C values, and diagnoses. The primary outcome was the frequency of dosage adjustments adherent to CDSS' recommendations. Out of 436 patients, 20 (5%) patients were included. In this study of 20 patients, 7 (33%) were prescribed drugs that required dosage adjustments due to their impaired kidney function. Across these patients, dosage adjustment was indicated in 11 prescriptions, and 8 (73%) of these dosages were adjusted as recommended by the CDSS. The study observed good concordance between clinical practice and the CDSS' recommendations on dosage adjustment in paediatrics. This supports the potential of PEDeDose to facilitate dosing and maintain quality of drug prescribing in children with kidney impairment. Considering the complexity of drug prescribing in this patient population, the support provided by PEDeDose may benefit paediatric patients and their caregivers beyond a specialised university hospital setting.