Medical Students' and Internal Medicine Trainees' Knowledge of Drug Prescribing Recommendations in Older Patients with Impaired Kidney Function

Abstract

Background: Numerous medications used in older adults require dose modification or should be avoided in individuals with impaired kidney function.

Purpose: To assess medical students' and physicians' knowledge of drug prescribing recommendations in older patients with estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73m².

Patients and methods: A survey comprising a list of 64 drugs conducted in 183 medical students (Students), and 138 post-graduate trainees in internal medicine (Physicians). The respondents were asked to classify each drug into one of three categories: 1) no renal precautions; 2) dose should be reduced; and 3) medication should be avoided.

Results: A range of 16.9-68.3% students and 14.5-81.2% physicians correctly classified drugs in the category "No renal precautions." Drugs requiring dose reduction were correctly classified by 6-67.2% students, and 24.6-85.5% physicians. For drugs that should be avoided in subjects with eGFR < 30 mL/min/1.73m², the range was 6-44.8% in the Students, and 8.7-76.1% in the Physicians. The Physicians did better than the Students by classifying five drugs that do not require renal precautions, 12 drugs requiring dose reduction, and six medications that should be avoided. The Students had a higher percentage of correct answers for seven drugs in the category "no renal precautions," and one drug requiring dose reduction.

Conclusion: Medical students and post-graduate trainees in internal medicine have poor knowledge of drug prescribing recommendations in older patients with renal impairment.

Keywords: chronic kidney disease; drug dosing; knowledge; older; reduced glomerular filtration rate.