Adaptação transcultural e validação do instrumento PAIR - Pharmacotherapy Assessment in Chronic Renal Disease –para aplicação em renais crônicos no Brasil

Abstract

Chronic kidney disease (CKD) is a global public health problem. In Brazil, about 126,000 people undergo renal replacement therapy, more than twice as much as there was at the beginning of the last century. This population is often elderly, has multiple comorbidities and takes polypharmacy. These factors, with renal impairment, expose this population to drug related problems (DRPs), which may interfere with the thera peutic outcome. Tools directed to the management of DRPs in chronic renal patients are important, however, they have not been explored in Brazil. In this context, the present study aimed to perform the cross cultural adaptation and validation of the PAIR ( Pharmacotherapy Assessment in Chronic Renal Disease) instrument for Brazil. The PAIR comprises a set of DRPs considered clinically significant for CKD, originally developed in Canada, which works as a check list so the pharmacist can assess pharmacotherapy of these patients. The study was carried out in two stages. In the first, the PAIR was submitted to the procedures of cross cultural adaptation following internationally accepted standards: translation, synthesis, back translation, analysis by a committee of experts and pre test of the preliminary version. After adjusting words and excluding 6 DRPs, due to the non applicability to the Brazilian context, the final version of the PAIR in Portuguese was obtained. In the second, the translated and adapted inst rument was evaluated for reliability, conceptual validity and responsiveness being performed a retrospective longitudinal observational study. It was also evaluated the prevalence of PRMs in a sample of individuals with CKD in conservative treatment. A mea n of 1.26 ± 0.96 DRPs/ patient was identified with the PAIR, being the most prevalent category "interaction and medication taken inadequately" ( In the inter rater reliability coefficient k ranged from 0.58 to 0.94, and in the test retest reliabilit y ranged from 0.79 to 1.00, revealing moderate to perfect level of agreement . In the conceptual validity, a mean of 1.60 ± 1.24 DRPs/ patient was identified by the nephrologist, using their clinical judgment, compared to 1.33 ± 0.76 DRPs/ patient identifie their clinical judgment, compared to 1.33 ± 0.76 DRPs/ patient identified by the d by the pharmacist, using PAIR (p=0.07), demonstrating that PAIR allowed the identification pharmacist, using PAIR (p=0.07), demonstrating that PAIR allowed the identification of clinically significant DRPs. In the analysis of responsiveness, a mean of 1.26 ± of clinically significant DRPs. In the analysis of responsiveness, a mean of 1.26 ± 0.96 DRPs/ patient was identified in the preintervention and 1.11 ± 1.02 DRPs/ 0.96 DRPs/ patient was identified in the preintervention and 1.11 ± 1.02 DRPs/ patient in the postintervention (p=0.17) by the pharmacist, using PAIR, it was not patient in the postintervention (p=0.17) by the pharmacist, using PAIR, it was not possible to detect a difference in the number of DRPs between the periods.possible to detect a difference in the number of DRPs between the periods. The The number of DRPs was higher in patients with renal function <30ml/ min/ 1,73mnumber of DRPs was higher in patients with renal function <30ml/ min/ 1,73m22 (r= (r= --0.28 p=0.0010.28 p=0.001) and in patients with higher number of medications (pre) and in patients with higher number of medications (pre--intervention: r= intervention: r= 0.221, p=0.02 and postintervention: r =0.329, p=0.001). Considering the results 0.221, p=0.02 and postintervention: r =0.329, p=0.001). Considering the results obtained, it was concluded that patients with CKD have obtained, it was concluded that patients with CKD have clinically significant clinically significant DRPs DRPs that require pharmathat require pharmaceutical intervention and that PAIR has been able to identify ceutical intervention and that PAIR has been able to identify these DRPs, constituting a new instrument, validated for use in Brazil.these DRPs, constituting a new instrument, validated for use in Brazil.