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Observational Study
. 2020 Oct-Dec;42(4):400-412.
doi: 10.1590/2175-8239-JBN-2019-0205.

Pharmacotherapy assessment in chronic kidney disease: validation of the PAIR instrument for use in Brazil

[Article in English, Portuguese]
Alessandra Batista Marquito  1 , Hélady Sanders Pinheiro  1   2 , Natália Maria da Silva Fernandes  1   2 , Rogério Baumgratz de Paula  1   2
Affiliations
Observational Study

Pharmacotherapy assessment in chronic kidney disease: validation of the PAIR instrument for use in Brazil

[Article in English, Portuguese]
Alessandra Batista Marquito et al. J Bras Nefrol. 2020 Oct-Dec.

Abstract
in English, Portuguese

Individuals with chronic kidney disease (CKD) use polypharmacy, which, in combination with renal impairment, exposes them to the risk of drug-related problems (DRPs). There are no available tools in Brazil to systematically assess the pharmacotherapy and management of DRPs in this population. Therefore, the objective of this work was to validate the PAIR instrument (Pharmacotherapy Assessment in Chronic Renal Disease) for use in Brazilian Portuguese. This is a retrospective longitudinal observational study. Medical records from 100 CKD patients under conservative treatment, between 2016 and 2017, in a nephrology clinic, were analyzed. PAIR was applied by pharmacists in two consultations of the same patient, with an interval of 6 months. Reliability, conceptual validity, responsiveness of the instrument and prevalence of DRPs in the studied sample were assessed. A mean of 1.26 ± 0.96 DRPs/patient was identified. Inter-rater reliability coefficients (k) ranged from 0.58 to 0.94 and from 0.79 to 1.00 for test-retest, revealing moderate to perfect level of agreement. In conceptual validity, a mean of 1.60 ± 1.24 DRPs/patient was identified by the nephrologist through clinical judgment, compared to 1.33±0.76 DRPs/patient identified by the pharmacist using PAIR (p = 0.07). Therefore PAIR allowed the identification of clinically significant DRPs. In responsiveness, a mean of 1.26 ± 0.96 DRPs/patient was identified at the first consultation and 1.11 ± 1.02 DRPs/patient at the subsequent consultation (p = 0.17) by the pharmacist using PAIR. The number of DRPs between the periods did not change. As a conclusion, the PAIR allowed the identification of clinically significant DRPs in CKD, constituting a new validated instrument to be used in Brazil.

Pacientes com doença renal crônica (DRC) utilizam polifarmácia, que, associada ao comprometimento renal, os expõe ao risco de problemas relacionados a medicamentos (PRMs). No Brasil, não existem instrumentos para sistematizar a avaliação da farmacoterapia e a gestão de PRMs nessa população. Portanto, o objetivo deste trabalho foi validar o instrumento PAIR (Pharmacotherapy Assessment in Chronic Renal Disease) para uso em português brasileiro. Trata-se de um estudo observacional longitudinal retrospectivo. Foram analisados prontuários de 100 pacientes com DRC, em tratamento conservador, atendidos entre 2016 e 2017, em clínica de nefrologia. O PAIR foi aplicado por farmacêuticos em duas consultas do mesmo paciente, com intervalo de 6 meses. Avaliou-se confiabilidade, validade conceitual, responsividade do instrumento e prevalência de PRMs na amostra. Uma média de 1,26 ± 0,96 PRM/paciente foi identificada. Na confiabilidade entre avaliadores, o coeficiente k variou de 0,58 a 0,94 e no teste-reteste, de 0,79 a 1,00, revelando grau de concordância moderada a perfeita. Na validade conceitual, uma média de 1,60±1,24 PRM/paciente foi identificada pelo nefrologista, por meio do julgamento clínico, comparado com 1,33 ± 0,76 PRM/paciente identificada pelo farmacêutico, usando o PAIR (p = 0,07). Portanto, o PAIR permitiu identificar PRMs clinicamente significativos. Na responsidade, uma média de 1,26 ± 0,96 PRM/paciente foi identificada na primeira consulta e 1,11 ± 1,02 PRM/paciente na consulta subsequente (p = 0,17) pelo farmacêutico, usando o PAIR, não sendo observada diferença no número de PRMs entre os períodos. Dessa forma, o PAIR permitiu identificar PRMs clinicamente significativos em pacientes com DRC, constituindo um novo instrumento validado para ser utilizado no Brasil.

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Conflict of interest statement

Conflict of interests

The authors declare no conflicts of personal, commercial, academic, political and financial interests in this manuscript.

Figures

Figure 1
Figure 1. Percentage distribution of the number of DRPs identified per patient according to the estimated glomerular filtration rate. *Chisquared test, p = 0.05.
Figure 2
Figure 2. Distribution of DRPs identified during outpatient follow-up, assessed on two occasions within a minimum of six months.
See this image and copyright information in PMC

Comment in

References

    1. Crews DC, Bello AK, Saadi G. Editorial do Dia Mundial do Rim 2019 - impacto, acesso e disparidades na doença renal. [2019 mar 21];J Bras Nefrol. 2019 Mar;41(1):1–9. [Internet] Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002019005....
    1. Jesus NM, Souza GF, Mendes-Rodrigues C, Almeida OP, Neto, Rodrigues DDM, Cunha CM. Qualidade de vida de indivíduos com doença renal crônica em tratamento dialítico. [2019 mar 21];J Bras Nefrol. 2019 Sep;41(3):364–374. [Internet] Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002019005....
    1. Sociedade Brasileira de Nefrologia (SBN) Censo de Diálise SBN 2018. São Paulo (SP): SBN; 2018. [2020 fev 13]. [Internet] Disponível em: https://sbn.org.br/categoria/censo-2018/
    1. Murphy D, McCulloch CE, Lin F, Banerjee T, Bragg-Gresham JL, Eberhardt MS, et al. Trends in prevalence of chronic kidney disease in the United States. Ann Intern Med. 2016 Oct;165(7):473–481. - PMC - PubMed
    1. Marinho AWGB, Penha AP, Silva MT, Galvão TF. Prevalência de doença renal crônica em adultos no Brasil: revisão sistemática da literatura. Cad Saúde Colet. 2017 Oct;25(3):379–388.

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