Abstract
Diabetes mellitus (DM) has been identified as a major cause of chronic kidney disease (CKD) and the kidney clearance rate changes considerably with the advancement of renal failure in the diabetic patients; thus, raising the probability of adverse effects, drug toxicity and treatment failure. The aim of this observational study involving the use of internship, which was held at the District Headquarter (DHQ) Teaching Hospital, Kohat was to evaluate the necessity of renal dose adjustment in diabetic patients admitted in the hospital. Ward rotations of fifteen patients with diabetes mellitus were studied and the case history filled out using a structured questionnaire that elicited demographic, medical/family history, chief complaints, lab investigations, comorbidity, and medications prescribed including dose, frequency and duration. The results showed that of the fifteen patients (eleven males and four females), three patients (20%) needed renal dose modification owing to high levels of serum creatinine exceeding 1.5mg/dl (indicating high levels of impaired renal functioning). In addition, CKD was identified in 46.6% of study population, hypertension was identified in 40% and gastroenteritis was identified in 13.3% which identifies the abilities of comorbidity in diabetic patients. Also identified were drug-related problems which were mainly adverse drug reactions (headache, vomiting, diarrhea and anorexia). These findings emphasize the value of integrating the use of renal function monitoring into regular diabetes management and changing the number of drugs used to achieve the safe and effective treatment. Conclusions are made by the study that clinical pharmacists should be at the center of treatment, irrational prescribing prevention, and patient safety through rational drug administration, and renal dose on-time adjustment in diabetic patients with impaired renal functioning.