Knowledge and Practice of Sudanese Clinical Pharmacists Towards Drugs that Require Dosage Adjustment in Renally Impaired Patients: A Cross-Sectional Study
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Abstract
Objectives: Clinical pharmacist has a vital role in the multidisciplinary team; they hold a critical role in the process of dosage adjustment and improving quality of life. One of the aspects of clinical pharmacy is dosage adjustment, especially for patients with renal impairment, since a wide variety of drugs are excreted in the urine throughout the kidneys. The aim of the study was to evaluate the knowledge and practice of Sudanese clinical pharmacists towards drugs that require dosage adjustment in renally impaired patients. Design: A cross-sectional descriptive study. Methods: The study was conducted from March to November 2020 among Sudanese clinical pharmacists. A pretested online questionnaire filled by a total of 255 Sudanese clinical pharmacists to evaluate knowledge in drug-specific renal dosing strategies and patterns of clinical practice. Data were analysed by SPSS, and descriptive statistics and Chi-square tests were conducted at a significance level of p < 0.05. Results: Most of participants were females (87.4%), 53.4% were at the age between 29-33. Most participants had a master’s degree (73.5%), and only 35% had undergone training on renal dose adjustment. Overall, 61.6% had demonstrated sufficient knowledge. Accurate identification of the need for renal dose adjustment was greatest for digoxin (84.6%), spironolactone (71.9%), lisinopril (70.8%), and enoxaparin (67.2%), and least for azithromycin (12.6%) and levofloxacin (12.3%). KDIGO guidelines were most frequently used for CKD (69.6%) and AKI (65.6%) classification, and creatinine clearance was the parameter most frequently used for monitoring CKD (36.8%) and AKI (25.3%). Prior training on renal dose adjustment (p = 0.022) and current clinical pharmacy practice (p = 0.005) were significant predictors of adequate knowledge. Conclusion: Most Sudanese clinical pharmacists demonstrated adequate knowledge about medications requiring dosage adjustments in patients with renal impairment. However, there remains a need to enhance interprofessional collaboration and address existing knowledge gaps.
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Copyright (c) 2025 Mazin S. Matar, Abdullah M. Elsheikheljanzoury, Suliman I. Hamid, Mazin M. A Ahmed, Ahmed A. Ali, Alaa M. Salih, Somia B. Ahmed, Safa Badi, Bashir A. Yousef
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons License All articles published in Annals of Medicine and Medical Sciences are licensed under a Creative Commons Attribution 4.0 International License.
Mazin S. Matar, Hospital Pharmacy Department, Jafar Ibn Auf Paediatric Hospital, Khartoum, Sudan.
Hospital Pharmacy Department, Jafar Ibn Auf Paediatric Hospital, Khartoum, Sudan.
Abdullah M. Elsheikheljanzoury, National Medical Supplies Fund, Khartoum, Sudan.
National Medical Supplies Fund, Khartoum, Sudan.
Suliman I. Hamid, Hospital Pharmacy Department, Ibrahim Malik Teaching, Khartoum, Sudan.
Hospital Pharmacy Department, Ibrahim Malik Teaching, Khartoum, Sudan.
Mazin M. A Ahmed, Hospital Pharmacy Department, Ahmed Gasim Hospital, Khartoum, Sudan.
Hospital Pharmacy Department, Ahmed Gasim Hospital, Khartoum, Sudan.
Ahmed A. Ali, Hospital Pharmacy Department, Ahmed Gasim Hospital, Khartoum, Sudan.
Hospital Pharmacy Department, Ahmed Gasim Hospital, Khartoum, Sudan.
Alaa M. Salih, Department of Clinical Pharmacy, Omdurman Islamic University, Khartoum, Sudan.
Department of Clinical Pharmacy, Omdurman Islamic University, Khartoum, Sudan.
Somia B. Ahmed, Department of Clinical Pharmacy, Omdurman Islamic University, Khartoum, Sudan.
Department of Clinical Pharmacy, Omdurman Islamic University, Khartoum, Sudan.
Safa Badi, Department of Clinical Pharmacy, Omdurman Islamic University, Khartoum, Sudan.
Department of Clinical Pharmacy, Omdurman Islamic University, Khartoum, Sudan.
Bashir A. Yousef, Department of Clinical Pharmacy and Pharmacology, Ibn Sina National College of Medical Studies, Jeddah, Saudi Arabia. Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan.
Department of Clinical Pharmacy and Pharmacology, Ibn Sina National College of Medical Studies, Jeddah, Saudi Arabia.
Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan.
[1] Vaidya SR, Aeddula NR. Chronic Kidney Disease. [Updated 2024 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535404/
[2] Bindroo S, Quintanilla Rodriguez BS, Challa HJ. Renal Failure (Archived). 2023 Sep 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 30085554.
[3] Goyal A, Daneshpajouhnejad P, Hashmi MF, et al. Acute Kidney Injury. [Updated 2023 Nov 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441896/
[4] Doogue MP, Polasek TM. Drug dosing in renal disease. Clin Biochem Rev. 2011;32(2):69-73
[5] Gounden V, Bhatt H, Jialal I. Renal Function Tests. [Updated 2024 Jul 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507821/
[6] Verbeeck RK, Musuamba FT. Pharmacokinetics and dosage adjustment in patients with renal dysfunction. Eur J Clin Pharmacol. 2009;65(8):757-73. https://doi.org/10.1007/s00228-009-0678-8
[7] Bassett E, Frantzen L, Zabel K. Evaluation of Pharmacist Renal Dose Adjustments and Planning for Future Evaluations of Pharmacist Services. Hosp Pharm. 2021;56(5):416-423. https://doi.org/10.1177/0018578720918363
[8] Ruiz-Ramos J, Hernández MH, Juanes-Borrego AM, Milà R, Mangues-Bafalluy MA, Mestres C. The Impact of Pharmaceutical Care in Multidisciplinary Teams on Health Outcomes: Systematic Review and Meta-Analysis. J Am Med Dir Assoc. 2021;22(12):2518-2526. https://doi.org/10.1016/j.jamda.2021.05.038
[9] Çakır A, Memiş H, Gün ZÜ, Bıçakcıoğlu M. Evaluation of Drug-Related Problems of Intensive Care Unit Patients by Clinical Pharmacists: A Retrospective Study. Turk J Pharm Sci. 2024;21(4):274-283. https://doi.org/10.4274/tjps.galenos.2023.44459
[10] Berry K, Postlmayr L, Shiltz D, Parker J, Ice C. Impact of an inpatient pharmacist-driven renal dosing policy on order verification time and patient safety. SAGE Open Med. 2024;12:20503121241233223. https://doi.org/10.1177/20503121241233223
[11] Alqurashi BY, Elsamadisi PS, Aseeri MA, Ismail SE. The Impact of Role of Pharmacists in Renal Dosage Adjustment Program on Renal Drug Dosing Errors: A Quasi-Experimental Study. Saudi J Kidney Dis Transpl. 2021;32(1):111-117. https://doi.org/10.4103/1319-2442.318512
[12] Florkowski CM, Chew-Harris JS. Methods of Estimating GFR - Different Equations Including CKD-EPI. Clin Biochem Rev. 2011;32(2):75-9
[13] Sunder S, Jayaraman R, Mahapatra HS, Sathi S, Ramanan V, Kanchi P, Gupta A, Daksh SK, Ram P. Estimation of renal function in the intensive care unit: the covert concepts brought to light. J Intensive Care. 2014;2(1):31. https://doi.org/10.1186/2052-0492-2-31
[14] Sheikh AM, Rwegerera GM, Godman B, Habte D. Adjustments of medication dosages in patients with renal impairment in Botswana; findings and implications to improve patient care. Hosp Pract (1995). 2019;47(5):231-240. https://doi.org/10.1080/21548331.2019.1685800
[15] Kyriakopoulos C, Gupta V. Renal Failure Drug Dose Adjustments. [Updated 2024 Jul 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560512/
[16] Teh XR, Lee SW. Pharmacists’ attitude, self‐reported knowledge and practice of dosage adjustment among chronic kidney disease patients in Malaysia. Journal of Pharmacy Practice and Research. 2019;49(2):179-85. https://doi.org/10.1002/jppr.1450
[17] Ali S, Badi S, Yousef B. Physicians’ knowledge and practice with regard to acute kidney injury at Omdurman Military Hospital: A cross-sectional survey. Int J Health Allied Sci. 2020;9(1):39. https://doi.org/10.4103/ijhas.IJHAS_97_19
[18] Hamadouk RM, Yousef BA, Albashair ED, Mohammed FM, Arbab AH. Perceptions of Community Pharmacists Towards Patient Counseling and Continuing Pharmacy Education Programs in Sudan. Integr Pharm Res Pract. 2023;12:77-85. https://doi.org/10.2147/IPRP.S406219
[19] Ibrahim M, Badi S, Yousef B. Knowledge and practice of community pharmacists toward dispensing of cough medications for children Khartoum State: A cross-sectional study. Intern J Health Allied Sci. 2020;9:147-52. https://doi.org/10.4103/ijhas.IJHAS_120_19
[20] Badi S, Hamed A, Abualama M, Mustafa M, Abdulraheem M, Yousef B. Knowledge, attitude, and practice of sudanese pharmacists toward COVID-19 in Khartoum State, Sudan: An online-based cross-sectional study. Libyan International Medical University Journal. 2021;6(01):19-26. https://doi.org/10.4103/LIUJ.LIUJ_42_20
[21] Ahmed KO, Taj Eldin I, Yousif M, Albarraq AA, Yousef BA, Ahmed N, Babiker A. Clinical Pharmacist's Intervention to Improve Medication Titration for Heart Failure: First Experience from Sudan. Integr Pharm Res Pract. 2021;10:135-143. https://doi.org/10.2147/IPRP.S341621
[22] Abudleek MF, Adam ME, Ahmed KO, Yousef BA. Doctors' attitude and satisfaction toward clinical pharmacists' role at Omdurman Military Hospital: A descriptive cross-sectional study. Matrix Science Medica. 2022;6(3):80-4. https://doi.org/10.4103/mtsm.mtsm_22_21
[23] Salim AM, Elhada AH, Elgizoli B. Exploring clinical pharmacists' perception of their impact on healthcare in Khartoum State, Sudan. J Res Pharm Pract. 2016;5(4):272-278. https://doi.org/10.4103/2279-042X.192459
[24] Elsadig H, Weiss M, Scott J, Laaksonen R. Exploring the challenges for clinical pharmacists in Sudan. Int J Clin Pharm. 2017;39(5):1047-1054. https://doi.org/10.1007/s11096-017-0521-8
[25] Aldomah MA, Ahmed YA, Ezaldeen AY, Aldomah MA, Nasir RA, Abdulraheem MA, Yousef BA, Badi S. Community Pharmacists' Knowledge and Practice toward Upper Respiratory Tract Infections in Khartoum State: A Cross-Sectional Survey. Matrix Science Medica. 2022;6(2):34-9. https://doi.org/10.4103/mtsm.mtsm_55_20
[26] Babiker LA, Babiker AO, Badawi BA, Abdalla RA, Abdalla RM, Hassan ZF, Mohammed ZA, Marzoug ME, Yousef BA, Badi S. Knowledge and practice about mycetoma infection among community pharmacists in Khartoum State: A descriptive cross-sectional study. Informatics in Medicine Unlocked. 2023;37:101175. https://doi.org/10.1016/j.imu.2023.101175
[27] Awdishu L, Maxson R, Gratt C, Rubenzik T, Battistella M. KDIGO 2024 clinical practice guideline on evaluation and management of chronic kidney disease: A primer on what pharmacists need to know. Am J Health Syst Pharm. 2025;82(12):660-671. https://doi.org/10.1093/ajhp/zxaf044
[28] Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105(4S):S117-S314. https://doi.org/10.1016/j.kint.2023.10.018
[29] Cucci MD, Gerlach AT, Mangira C, Murphy CV, Roberts JA, Udy AA, Dowling TC, Mullen CL. Performance of different body weights in the Cockcroft-Gault equation in critically ill patients with and without augmented renal clearance: A multicenter cohort. Pharmacotherapy. 2023;43(11):1131-1138. https://doi.org/10.1002/phar.2743
[30] Winter MA, Guhr KN, Berg GM. Impact of various body weights and serum creatinine concentrations on the bias and accuracy of the Cockcroft-Gault equation. Pharmacotherapy. 2012;32(7):604-12. https://doi.org/10.1002/j.1875-9114.2012.01098.x
[31] Brown DL, Masselink AJ, Lalla CD. Functional range of creatinine clearance for renal drug dosing: a practical solution to the controversy of which weight to use in the Cockcroft-Gault equation. Ann Pharmacother. 2013;47(7-8):1039-44. https://doi.org/10.1345/aph.1S176
[32] Li H, Radhakrishnan J. A pharmacist-physician collaborative care model in chronic kidney disease. J Clin Hypertens (Greenwich). 2021;23(11):2026-2029. https://doi.org/10.1111/jch.14372
[33] Cooney D, Moon H, Liu Y, Miller RT, Perzynski A, Watts B, Drawz PE. A pharmacist based intervention to improve the care of patients with CKD: a pragmatic, randomized, controlled trial. BMC Nephrol. 2015;16:56. https://doi.org/10.1186/s12882-015-0052-2
[34] Cheung D, Go A, Cooper M, Schwarz K. Evaluation of a pharmacist‐driven renal dosing protocol at an academic medical center. Journal of the American College of Clinical Pharmacy. 2020;3(4):736-42. https://doi.org/10.1002/jac5.1230
[35] Saad R, Hallit S, Chahine B. Evaluation of renal drug dosing adjustment in chronic kidney disease patients at two university hospitals in Lebanon. Pharm Pract (Granada). 2019;17(1):1304. https://doi.org/10.18549/PharmPract.2019.1.1304
[36] Ruiz-Boy S, Rodriguez-Reyes M, Clos-Soldevila J, Rovira-Illamola M. Appropriateness of drug prescriptions in patients with chronic kidney disease in primary care: a double-center retrospective study. BMC Prim Care. 2022;23(1):323. https://doi.org/10.1186/s12875-022-01931-4