Faculty Collaboration Database

Frequency of serum creatinine monitoring during allopurinol therapy in ambulatory patients. Ann Pharmacother 2006 Mar;40(3):386-91

Date

02/16/2006

Pubmed ID

16478808

DOI

10.1345/aph.1G589

Scopus ID

2-s2.0-33645086119 (requires institutional sign-in at Scopus site)   14 Citations

Abstract

BACKGROUND: Allopurinol dosage reduction is recommended in patients with renal dysfunction because drug toxicity risk is increased. Little information is available about serum creatinine (SCr) monitoring in ambulatory patients taking allopurinol.

OBJECTIVE: To evaluate SCr monitoring among patients prescribed allopurinol, identify associated factors, and evaluate administrative data in assessing monitoring.

METHODS: Information for this retrospective cohort study was drawn from a dataset of 2 020 037 individuals; approximately 200 000 members from each of 10 organizations. Study patients had received at least one year of ongoing allopurinol prescription dispensings. Patient variables analyzed included age, gender, chronic diseases, outpatient visits, hospitalizations, gout diagnosis, and SCr monitoring. A random sample of medical records was reviewed to assess the accuracy of the automated data. Statistical analysis included descriptive and logistic regression techniques.

RESULTS: Overall, 1139 (26%) of 4357 patients did not have SCr monitoring. For individuals without recent hospitalization, factors protective against lack of monitoring were increasing age (OR 0.77 per 10 y; 95% CI 0.74 to 0.79), more chronic diseases (OR 0.81; 95% CI 0.78 to 0.83), more outpatient visits (OR 0.87 per 5 visits; 95% CI 0.83 to 0.91), and gout diagnosis (OR 0.74; 95% CI 0.65 to 0.85). The sensitivity and specificity of administrative data compared with medical records for SCr monitoring were 92% and 65%, respectively.

CONCLUSIONS: More than one-fourth of patients dispensed allopurinol did not have SCr monitoring during one year of therapy. Lack of monitoring and lack of subsequent possible dosage adjustment put patients at increased risk of allopurinol toxicity.

Author List

Raebel MA, McClure DL, Simon SR, Chan KA, Feldstein AC, Gunter MJ, Lafata JE, Harrold L, Nelson WW, Platt R

Author

David L. McClure PhD Adjunct Assistant Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Allopurinol
Chronic Disease
Cohort Studies
Creatinine
Databases, Factual
Female
Gout Suppressants
Health Maintenance Organizations
Humans
Insurance, Health
Male
Middle Aged
Monitoring, Physiologic
Retrospective Studies