Drug Dosing Rationality Based on Jelliffe Equation in Acute Kidney Injury


Dealinda Husnasya(1), Mawardi Ihsan(2*)

(1) Graduate Program of Pharmacy, Universitas Gadjah Mada, Yogyakarta
(2) Department of Pharmacology and Clinical Pharmacy, Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author


Patients with Acute Kidney Injury (AKI) experience changes in unstable kidney function which is characterized by instability of serum creatinine values that affect the concentration of drugs in the body. Therefore, adjusting the dosage and frequency of the drug is an important concern. This study aimed to determine the proportion of rational drug dosage regimens in hospitalized patients with AKI. This research was a retrospective observation study with cross sectional design. Sample collection was carried out using simple random sampling method for patients who were hospitalized with AKI during January 1st till December 31, 2017. Data analysis was carried out descriptively to see the proportion and description of the rationality of each dosage regimen given to patients. This research was conducted at the dr. Sardjito General Hospital Yogyakarta. The results showed that the proportion of rational drug dosage regimens given to 100 inpatients with AKI was 60.00% based on literature and 94.12% based on predictive steady-state concentration calculation. Irrationality of the dosing regimen because of administration interval was 52.84%; because of dose was 17.05%; and because of both were 30.11%. The irrationality based on predictive steady concentration showed that drug concentration below minimum effective concentration was 33.33% and over minimum toxic concentration was 66.67%. The proportion of rational drug dosage regimens given to 100 inpatients with AKI based on literature and calculation of predictive steady-state concentrations were quite high. However, some dosing regimens were still irrationally prescribed with the irrationality form were generally in the form of irrational delivery interval with excessive drug concentration.


Rationality; dose regimens; Jelliffe equation; acute kidney injury

Full Text:



1. Ali T, Khan I, Simpson W, et al. Incidence and Outcomes in Acute Kidney Injury: A Comprehensive Population-Based Study. J Am Soc Nephrol. 2007;18:1292-1298.

2. Hsu C, McCulloch C, Fan D, Ordonez J, Chertow G, Go A. Community-Based Incidence of Acute Renal Failure. Kidney Int. 2007;72:208-212.

3. Susantitaphong P, Cruz DN, Cerda J, et al. World Incidence of AKI: A Meta-Analysis. Clin J Am Soc Nephrol. 2013;8(9):1482-1493.

4. Bell M, SWING, Granath F, Schön S, Ekbom A, Martling C-R. Continuous renal replacement therapy is associated with less chronic renal failure than intermittent haemodialysis after acute renal failure. Intensive Care Med. 2007;33(5):773-780.

5. Suhardi. Kegawatan pada Gagal Ginjal Akut. In: Pertemuan Ilmiah Tahunan Ilmu Penyakit Dalam. Yogyakarta: Universitas Gadjah Mada, Fakultas Kedokteran; 2000:62-67.

6. Chertow GM, Burdick E, Honour M, Bonventre J V., Bates DW. Acute Kidney Injury, Mortality, Length of Stay, and Costs in Hospitalized Patients. J Am Soc Nephrol. 2005;16(11):3365-3370.

7. Jelliffe R. Estimation of Creatinine Clearance in Patients with Unstable Renal Function, without a Urine Specimen. Am J Nephrol. 2002;22(4):320-324.

8. Badan Pengawas Obat dan Makanan Republik Indonesia. Gagal Ginjal. Badan Pengawas Obat dan Makanan Republik Indonesia. http://pionas.pom.go.id/ioni/lampiran-3-gagal-ginjal. Published 2015. Accessed September 22, 2017.

9. Sinaga C, Tjitrosantoso H, Fatimalawi. Evaluasi Kerasionalan Penggunaan Antibiotik pada Pasien Gagal Ginjal di RSUP Prof. Dr. R.D. Kandou Manado. Pharmacon. 2017;6(3):2302-2493.

10. Sihombing JP, Hakim L, Kusharwanti AMW. Evaluasi Dosis Digoksin Pada Pasien Gagal Jantung dengan Disfungsi Ginjal di RSUP dr. Sardjito Yogyakarta. J Manaj dan Pelayanan Farm. 2011;1(3):207-210.

11. Fahimi F, Emami S, Farokhi FR. The Rate of Antibiotic Dosage Adjustment in Renal Dysfunction. Iran J Pharm Res. 2012;11(1):157-161.

12. McCoy AB, Waitman LR, Gadd CS, et al. A Computerized Provider Order Entry Intervention for Medication Safety During Acute Kidney Injury: A Quality Improvement Report. Am J Kidney Dis. 2010;56(5):832-841. http://dx.doi.org/10.1053/j.ajkd.2010.05.024.

13. Awdishu L, Connor AI, Bouchard J, Macedo E, Chertow GM, Mehta RL. Use of Estimating Equations for Dosing Antimicrobials in Patients with Acute Kidney Injury Not Receiving Renal Replacement Therapy. J Clin Med. 2018;7(8):211-220. doi:10.3390/jcm7080211

14. Kenward R, Tan CK. Penggunaan Obat Pada Gangguan Ginjal. In: Aslam M, Tan CK, Prayitno A, eds. Farmasi Klinis: Menuju Pengobatan Rasional Dan Penghargaan Pilihan Pasien. Jakarta: PT. Elex Media Komputindo Gramedia; 2003.

15. Lemeshow S, Hosmer Jr. DW, Klar J, Lwanga SK. Adequacy of Sample Size in Health Studies. Chichester: John Wiley & Sons; 1990.

16. Direktorat Bina Gizi dan Kesehatan Ibu dan Anak. Pedoman Pelayanan Gizi Di Puskesmas. Jakarta: Kementerian Kesehatan Republik Indonesia; 2014.

17. Obialo CI, Crowell AK, Okonofua EC. Acute Renal Failure Mortality in Hospitalized African Americans: Age and Gender Considerations. J Natl Med Assoc. 2002;94(3):127-134.

18. Harty J. Prevention and Management of Acute Kidney Injury. Ulster Med J. 2014;83(3):149-157.

19. Prough DS. Physiologic Acid-base and Electrolyte Changes in Acute and Chronic Renal Failure Patients. Anesthesiol Clin North America. 2000;18(4):809-833.

20. Adams D, de Jonge R, van der Cammen T, Zietse R, Hoorn EJ. Acute Kidney Injury in Patients Presenting with Hyponatremia. J Nephrol. 2011;24(6):749-755.

21. Lehnhardt A, Kemper MJ. Pathogenesis, Diagnosis and Management of Hyperkalemia. Pediatr Nephrol. 2011;26:377-384. doi:10.1007/s00467-010-1699-3

22. Falconnier AD, Haefeli WE, Schoenenberger RA, Surber C, Martin-Facklam M. Drug Dosage in Patients with Renal Failure Optimized by Immediate Concurrent Feedback. J Gen Intern Med. 2001;16(6):369-375.

23. Stamatakis MK. Acute Kidney Injury. In: Chisholm-Burns MA, Schwinghammer TL, Wells BG, Malone PM, Kolesar JM, DiPiro JT, eds. Pharmacotherapy: Principles & Practice. Fourth. New York: McGraw Hill; 2016:387-398.

24. Sunder S, Jayaraman R, Mahapatra HS, et al. Estimation of Renal Function in the Intensive Care Unit: the Covert Concepts Brought to Light. J Intensive Care. 2014;2(31):1-7.

25. Alahdal AM, Elberry AA. Evaluation of Applying Drug Dose Adjustment by Physicians in Patients with Renal Impairment. Saudi Pharm J. 2012;20(3):217-220.

26. Kang J-S, Lee M-H. Overview of Therapeutic Drug Monitoring. Korean J Intern Med. 2009;24(1):1-10.

27. Schulz M, Iwersen-Bergmann S, Andresen H, Schmoldt A. Therapeutic and Toxic Blood Concentrations of Nearly 1,000 Drugs and Other Xenobiotics. Crit Care. 2012;16(4):R136.

28. Lemos J de A, Costa CR, de Araújo CR, Souza LKH e, Silva M do RR. Susceptibility Testing of Candida Albicans Isolated from Oropharyngeal Mucosa of HIV+ Patients to Fluconazole, Amphotericin B and Caspofungin. Killing Kinetics of Caspofungin and Amphotericin B Against Fluconazole Resistant and Susceptible Isolates. Brazillian J Microbiol. 2009;40:163-169.

29. Grillon A, Schramm F, Kleinberg M, Jehl F. Comparative Activity of Ciprofloxacin, Levofloxacin and Moxifloxacin Against Klebsiella pneumoniae, Pseudomonas aeruginosa and Stenotrophomonas maltophilia Assessed by Minimum Inhibitory Concentrations and Time-Kill Studies. PLoS One. 2016;11(6):1-10. doi:10.1371/journal.pone.0156690

30. Biedenbach DJ, Badal RE, Huang M-Y, et al. In Vitro Activity of Oral Antimicrobial Agents against Pathogens Associated with Community-Acquired Upper Respiratory Tract and Urinary Tract Infections: A Five Country Surveillance Study. Infect Dis Ther. 2016;5(2):139-153.

31. Sader HS, Huband MD, Castanheira M, Flamm RK. Pseudomonas aeruginosa Antimicrobial Susceptibility Results from Four Years (2012 to 2015) of the International Network for Optimal Resistance Monitoring Program in the United States. Antimicrob Agents Chemother. 2017;61:e02252-16.

DOI: https://doi.org/10.22146/jmpf.39921

Article Metrics

Abstract views : 518 | views : 3744


  • There are currently no refbacks.

Copyright (c) 2019 JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

©Jurnal Manajemen dan Pelayanan Farmasi
Faculty of Pharmacy
Universitas Gadjah Mada
Creative Commons License
View My Stats