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Drug Safety
Published in: Drug Safety 7/2011

01-07-2011 | Original Research Article

Adherence to Biochemical Monitoring Recommendations in Patients Starting with Renin Angiotensin System Inhibitors

A Retrospective Cohort Study in the Netherlands

Authors: Janet E. M. Bootsma, MD, Margreet F. Warlé-van Herwaarden, André L. M. Verbeek, Peter Füssenich, Peter A. G. M. De Smet, Marcel G. Olde Rikkert, Cornelis Kramers

Published in: Drug Safety | Issue 7/2011

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Abstract

Background: Renin angiotensin system inhibitors (RASIs) are frequently involved in serious adverse events. These events principally occur in high-risk patients and often arise within the first days after treatment initiation; therefore, guidelines recommend biochemical monitoring within 3 weeks after the start of therapy with RASIs.
Objective: The purpose of this study was to examine the level of biochemical monitoring directly after treatment initiation with RASIs in patients with different risk profiles and to study the attitudes of the physicians involved towards biochemical monitoring.
Methods: We carried out a retrospective analysis of 202 patients who started RASI therapy in 2006 in Groesbeek, the Netherlands. We determined the rate of serum creatinine and potassium monitoring within 3 weeks after the start of therapy. In addition, we studied the intentions and attitudes towards biochemical monitoring during RASI therapy among 68 general practitioners and medical specialists by way of a brief questionnaire.
Results: Serum creatinine and potassium monitoring after treatment initiation was performed in 34% and 28% of patients, respectively. Of all the patients, 29% had two or more additional risk factors for renal function deterioration. In these high-risk patients, creatinine was significantly less often monitored compared with low-risk patients (22% vs 39%). In contrast to these findings, the prescribing physicians claimed to check serum creatinine within 2 weeks after treatment initiation in 85% of their patients. Most of the prescribing physicians (88%) rated this monitoring as (very) important.
Conclusions: We demonstrated that, despite positive intentions of physicians, the biochemical monitoring recommendation in patients treated with RASIs is poorly met. In addition, serum creatinine monitoring was significantly less often performed in high-risk patients compared with low-risk patients.
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Metadata
Title
Adherence to Biochemical Monitoring Recommendations in Patients Starting with Renin Angiotensin System Inhibitors
A Retrospective Cohort Study in the Netherlands
Authors
Janet E. M. Bootsma, MD
Margreet F. Warlé-van Herwaarden
André L. M. Verbeek
Peter Füssenich
Peter A. G. M. De Smet
Marcel G. Olde Rikkert
Cornelis Kramers
Publication date
01-07-2011
Publisher
Springer International Publishing
Published in
Drug Safety / Issue 7/2011
Print ISSN: 0114-5916
Electronic ISSN: 1179-1942
DOI
https://doi.org/10.2165/11587250-000000000-00000

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