Hospital Pharmacy - May 2017 - 355

355

Corbin and Bossaer
Table 1. Patient Characteristics (N = 67).
Characteristic
Age, y
Median
Range
Sex
Male
Race, n (%)
Caucasian
African American
Other
Primary tumor site, n (%)
Head/neck
Lung
Other
Stage, n (%)
Locally advanced
Metastatic
Comorbidities, n (%)
Diabetes
Hypertension
Feeding tube, n (%)
Yes
Radiation, n (%)
Yes
Chemotherapy, n (%)
Combination
Concomitant nephrotoxin
NSAID
ACE/ARB
Diuretic
Other (eg, IV contrast)
Baseline renal function
SCr, mg/dL
CrCl, mL/min

Table 3. Univariate Analysis of Acute Kidney Injury.

Prenewsletter
cohort (n = 30)

Postnewsletter
cohort (n = 37)

59
33-74

57
40-76

15 (50)

20 (54.1)

28 (93.3)
1 (3.3)
1 (3.3)

35 (94.6)
0 (0)
2 (5.4)

6 (20)
17 (56.7)
7 (23.3)

32 (86.5)
5 (13.5)
0 (0)

16 (53.3)
14 (46.7)

18 (48.6)
19 (51.4)

6 (20)
16 (53.33)

5 (13.51)
21 (56.76)

4 (13.33)

8 (21.62)

20 (66.67)

30 (81.08)

23 (76.67)
25 (83.3)
8 (26.7)
12 (40)
8 (26.7)
18 (60)

31 (83.78)
36 (97.3)
8 (21.6)
11 (29.8)
9 (24.3)
35 (94.6)

0.81
109.9

0.76
112.5

Note. NSAID = nonsteroidal anti-inflammatory drug; ACE = angiotensinconverting enzyme inhibitor; ARB = angiotensin receptor blocker;
SCr = serum creatinine; CrCl = creatinine clearance; IV = intravenous.

Table 2. Results Before and After Newsletter
Implementation.

Cisplatin dose, average
Mannitol dose, average
Rate of AKI
AKI grade, median

Before
newsletter
(n = 30)

After
newsletter
(n = 37)

P value

59.4 mg
12.75 g
40%
1

54.9 mg
4.14 g
43%
1

.34a
.02a
.79b
.985c

Note. AKI = acute kidney injury.
a
Mann-Whitney U test.
b
Chi-square test.
c
Independent-samples median test.

Feeding tube
Radiation therapy
Hypertension
Cisplatin dose >75 mg/m2
Nephrotoxin
Mannitol use
Diabetes mellitus
Female gender

Odds ratio

95% CI

2.27
2.04
1.89
1.55
1.49
1.46
1.19
0.71

0.67-8.07
0.63-6.67
0.70-5.13
0.58-4.16
0.25-8.74
0.53-4.03
0.326-4.39
0.57-1.89

Note. CI = confidence interval.

Of the 67 patients, 12 (40%) in the prenewsletter group
experienced any grade AKI, whereas 16 (43%) in the postnewsletter group experienced any grade AKI (P = .79; Table
2). No risk factors were identified for AKI (Table 3).

Discussion
A newsletter as part of a comprehensive pharmacist-led
education program has been shown to influence prescribing
behavior.9 Our 2-page newsletter appeared to change prescriber behavior as well but, as with any retrospective
study, uncontrolled confounders may exist. One factor that
may have affected mannitol prescribing was education
regarding cisplatin nephroprotection strategies on inpatient
rounds. After the newsletter was distributed, the clinical
pharmacist on the inpatient rounding service began reviewing the data presented in the newsletter on a patient-specific
basis when cisplatin was prescribed. The influence of this
face-to-face education on the results was likely mitigated
by allowing a 6-month gap between cohorts for diffusion of
information.
Given that higher doses (>75 mg/m2) of cisplatin were not
associated with nephrotoxicity, the study population may
have been underpowered due to its small sample size (N =
67). In addition, there may be confounding differences in
baseline demographics. The prenewsletter group consisted
primarily of lung cancer patients (56.7%), whereas the postnewsletter group consisted primarily of head and neck cancer
patients (86.5%). As different chemotherapy regimens are
used for different malignancies, this could have affected the
results. However, the similar mean cisplatin dose in both
cohorts argues against this. Our study also suffers from the
inherent limitations of retrospective studies.
Mannitol's role as a nephroprotective agent remains unclear.
Morgan et al10 published data from a quasi-experiment recently
that differed from previous studies; they presented evidence
that mannitol does decrease cisplatin-induced nephrotoxicity.
There were methodological differences between the study by
Morgan et al and our study, including stricter inclusion criteria
as patients could only have received cisplatin monotherapy for



Table of Contents for the Digital Edition of Hospital Pharmacy - May 2017

Editorial, For Sale: FDA Priority Review Vouchers
Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Pharmacists’ Knowledge of the Cost of Laboratory Testing
Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Formulary Drug Reviews
Hospital Pharmacy - May 2017 - 317
Hospital Pharmacy - May 2017 - 318
Hospital Pharmacy - May 2017 - 319
Hospital Pharmacy - May 2017 - 320
Hospital Pharmacy - May 2017 - 321
Hospital Pharmacy - May 2017 - 322
Hospital Pharmacy - May 2017 - 323
Hospital Pharmacy - May 2017 - Editorial, For Sale: FDA Priority Review Vouchers
Hospital Pharmacy - May 2017 - 325
Hospital Pharmacy - May 2017 - Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Hospital Pharmacy - May 2017 - Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
Hospital Pharmacy - May 2017 - 328
Hospital Pharmacy - May 2017 - 329
Hospital Pharmacy - May 2017 - ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Hospital Pharmacy - May 2017 - 331
Hospital Pharmacy - May 2017 - 332
Hospital Pharmacy - May 2017 - 333
Hospital Pharmacy - May 2017 - Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Hospital Pharmacy - May 2017 - 335
Hospital Pharmacy - May 2017 - 336
Hospital Pharmacy - May 2017 - 337
Hospital Pharmacy - May 2017 - 338
Hospital Pharmacy - May 2017 - 339
Hospital Pharmacy - May 2017 - 340
Hospital Pharmacy - May 2017 - Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Hospital Pharmacy - May 2017 - 342
Hospital Pharmacy - May 2017 - 343
Hospital Pharmacy - May 2017 - 344
Hospital Pharmacy - May 2017 - 345
Hospital Pharmacy - May 2017 - 346
Hospital Pharmacy - May 2017 - 347
Hospital Pharmacy - May 2017 - Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Hospital Pharmacy - May 2017 - 349
Hospital Pharmacy - May 2017 - 350
Hospital Pharmacy - May 2017 - 351
Hospital Pharmacy - May 2017 - 352
Hospital Pharmacy - May 2017 - Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Hospital Pharmacy - May 2017 - 354
Hospital Pharmacy - May 2017 - 355
Hospital Pharmacy - May 2017 - 356
Hospital Pharmacy - May 2017 - Pharmacists’ Knowledge of the Cost of Laboratory Testing
Hospital Pharmacy - May 2017 - 358
Hospital Pharmacy - May 2017 - 359
Hospital Pharmacy - May 2017 - 360
Hospital Pharmacy - May 2017 - Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Hospital Pharmacy - May 2017 - 362
Hospital Pharmacy - May 2017 - 363
Hospital Pharmacy - May 2017 - 364
Hospital Pharmacy - May 2017 - 365
Hospital Pharmacy - May 2017 - 366
Hospital Pharmacy - May 2017 - Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Hospital Pharmacy - May 2017 - 368
Hospital Pharmacy - May 2017 - 369
Hospital Pharmacy - May 2017 - 370
Hospital Pharmacy - May 2017 - 371
Hospital Pharmacy - May 2017 - 372
Hospital Pharmacy - May 2017 - 373
Hospital Pharmacy - May 2017 - Formulary Drug Reviews
Hospital Pharmacy - May 2017 - 375
Hospital Pharmacy - May 2017 - 376
Hospital Pharmacy - May 2017 - 377
Hospital Pharmacy - May 2017 - 378
Hospital Pharmacy - May 2017 - 379
Hospital Pharmacy - May 2017 - 380
Hospital Pharmacy - May 2017 - 381
Hospital Pharmacy - May 2017 - 382
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