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Theses

Bon usage du médicament et insuffisance rénale

Abstract : Since medication misuse increases the risk of iatrogenic risk, dosage adjustrnent should be considered when prescribing in renal impairment. Medication misuse and its impact have seldom been studied in acute renal failure (RF). In this work, we assessed the rate of inappropriate orders on a hospital scale ; We also assessed the appropriateness of orders using standardized clinical cases (vignettes). These studies confirmed the high rate of inappropriate orders. Besides, many orders could lead to potential adverse effects,some potentially severe or letal. Another study demonstrated that the informations allowing accurate prescribing were often missing in clinical routine.In chronic RF, the data from EPIREL cohorte confirmed that a planified dialysis and an early, regular and specialized follow-up are associated with a higher quality of orders. These data showed that 6 months after starting dialysis the quality of prescriptions had improved. It was yet under-optimal, underlying the difficulty to conform to guidelines, even in specialized settings. These studies showed that renal function is not fully considered when prescribing, in hospitalized patients with acute RF, but also in the management of chronic RF. The impact of medication misuse is fully documented in chronic RF, where guidelines have been written. This work contributed in showing the significant impact of medication misuse in acute RF and the need of improvement in the management chronic IR, to conform with clinical guidelines.
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http://docnum.univ-lorraine.fr/prive/SCD_T_2004_0250_SALOMON.pdf
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https://hal.univ-lorraine.fr/tel-01746946
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Submitted on : Thursday, March 29, 2018 - 10:48:14 AM
Last modification on : Tuesday, September 1, 2020 - 3:17:53 PM

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  • HAL Id : tel-01746946, version 1

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Laurence Salomon. Bon usage du médicament et insuffisance rénale. Médecine humaine et pathologie. Université Henri Poincaré - Nancy 1, 2004. Français. ⟨NNT : 2004NAN10250⟩. ⟨tel-01746946⟩

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