Abstract. Treatment of diabetes mellitus with renal dysfunction required a drug adjustment. Drug adjustment must based on creatinin clearance (CrCl). This study aimed to evaluate of oral antidiabetic on type 2 diabetic patients with renal dysfunction in outpatient department of Dr. Sardjito, Yogyakarta. This study was observational with cross sectional design. Data collection was done retrospectively through patient’s medical records searching and review. The subjects were type 2 diabetic patients with renal dysfunction in outpatient department who met the inclusion criteria. Evaluation of antidiabetic in this study is done by comparing the patient’s dosage regimen obtained with literature. Literature used in this comparison was Drug Information handbook 20th Edition and Handbook of Renal Pharmacotherapy. The result showed that oral antidiabetic with the highest usage, 57 patient (57%) was single type and the lowest usage, 8 patient (8%) was three combination type. Type of oral antidiabetic with the highest usage was acarbose (36%) and metformin (14%). Out of 100 patients, 38 patient (38%) showed appropriate medication, 62 patient (62%) non-appropriate medication. From 149 case of medicine, the appropriate antidiabetic oral was 51,67% and non-appropriate antidiabetic oral was 48,32%. From this study showed that usage of oral antidiabetic without adjustment was still high. Consequently, the possibility of unachieved clinical outcome was greater.
Keywords: DM type 2, renal dysfunction, creatinin clearance, oral antidiabetic
- Alberti, K.G.M., Zimmet, P., dan Shaw, J. (2007). International Diabetes Federation: a consensus on Type 2 diabetes prevention. Diabetic Medicine, (24): 451–463.
- American Diabetic Association. (2015). Standards of Medical Care in Diabetes. Diabetes Care, (38): S1–S2.
- Arnouts, P., Bolignano, D., Nistor, I., Bilo, H., Gnudi, L., Heaf, J., dkk. (2014). Glucose-lowering drugs in patients with chronic kidney disease: a narrative review on pharmacokinetic properties. Nephrology Dialysis Transplantation. (29): 1284–1300.
- Elvina,R. (2011). Kajian Aspek Farmakokinetik Klinik Obat Antidiabetik pada Pasien Diabetes Mellitus Tipe 2 dengan Gangguan Fungsi Ginjal di Poliklinik Khusus RSUP Dr. M. Djamil Padang. Jurnal Ilmiah Universitas Andalas,Padang.
- Getachew, H., Tadesse, Y., dan Shibeshi, W. 2015. Drug dosage adjustment in hospitalized patients with renal impairment at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. BMC Nephrology, (16).
- Golightly, L.K., Teitelbaum, I., Kiser, T.H., Levin, D.A., Barber, G.R., Jones, M.A., dkk. (Editor). (2013). Renal Pharmacotherapy - Dosage Adjustment
- of Medications | Larry K Golightly | Springer.
- Hakim, L. (2013). Variabilitas Farmakokinetik dan Farmakodinamik, dalam: Farmakokinetik Klinik, Farmasi Klinik. Bursa Ilmu Yogyakarta. hal. 216–219.
- Hongdiyanto, A. (2014). Evaluasi Kerasionalan Pengobatan Diabetes Melitus Tipe 2 Pada Pasien Rawat Inap Di RSUP Prof. Dr. RD Kandou Manado Tahun 2013. PHARMACON, (3).
- Lipska, K.J., Bailey, C.J., dan Inzucchi, S.E. (2011). Use of Metformin in the Setting of Mild-to-Moderate Renal Insufficiency. Diabetes Care. (34): 1431–1437.
- Munar, M.Y. dan Singh, H. (2007). Drug dosing adjustments in patients with chronic kidney disease. American family physician. (75): 1487-1496.
- Nogueira, C., Souto, S.B., Vinha, E., Carvalho-Braga, D., dan Carvalho, D. (2013). Oral glucose lowering drugs in type 2 diabetic patients with chronic kidney disease.
- Osher, E. dan Stern, N. (2009). Obesity in Elderly Subjects: In sheep’s clothing perhaps, but still a wolf! Diabetes Care. (32): S398–S402.
- Saleem, A. dan Masood, I. (2016). Pattern and Predictors of Medication Dosing Errors in Chronic Kidney Disease Patients in Pakistan: A Single Center Retrospective Analysis. PLOS ONE. (11): e0158677.
- Shargel, L., Susanna, W.P., dan Andrew, B.C.Y. (2012). Biofarmasetika Dan Farmakokinetika Terapan, Kelima. ed. Pusat Penerbitan dan Percetakan Universitas Airlangga: Surabaya.
- Tucker, G.T., Casey, C., Phillips, P.J., Connor, H., Ward, J.D., dan Woods, H.F. (1981). Metformin kinetics in healthy subjects and in patients with diabetes mellitus. British journal of clinical pharmacology. (12): 235–246.