Renadaptor© is a software database, purely consultative, containing more then 2500 records concerning currently more than 1900 drugs. The use of the database is intuitive, easy and contains only information that is useful for prescribing medication. Using Renadaptor© is overall individual and destined to prescribing practitioners and clinical pharmacists. It is possible to integrate this database in a computerized physician order entry system (CPOE).
All pharmacotherapeutic classes are represented. One active ingredient of a drug can have several records, depending on the administration mode, and varying indications with very large dosages differences.
Access to the entire database requires a login and password (Figure 1), in the absence of which only a "Demo" version of 26 DCI is available. Some built-in versions no longer require these direct access codes.
Figure 1: Login screen
The research can be done by typing an operative word or by typing directly the drug INN name (Figure 2). It is also possible to search by therapeutic class. You can even search the brand name of the drug since brand names for more than 30 countries are listed in the database.
Figure 2: Search screen
Once the search completed, the drug or drugs you searched for are displayed in a list, in which the active ingredients can be sorted by alphabet or by therapeutic subclass (Figure 3).
A 3 colour code allows you to see at one glance if the dosage has to be adjusted or if the drug is contra-indicated. If the record is green, no adjustment has to be done. If the record is orange, an adjustment is necessary considering the 5 different stages of renal failure and/or a dialysis technique. If the record is red, the drug is contra-indicated for at least one of the 5 stages of renal failure or in dialysis. A selection by colour is then possible.
Figure 3: List screen
In one click on a drug name of the list screen, the specific record will open.
One record is composed of 2 pages:
The first page (Figure 4), the main page, goes straight to the point. You’ll find:
- The molecule classified by specialty, according to its pharmacological properties.
- Laboratory tests (therapeutic drug monitoring ...) and their goal range, used to adjust the drug dosage.
- The mode of administration (Oral, IV, SC, IM …)
- The loading dose
- The maintenance dose for healthy subjects.
- The maintenance doses adjusted to the 5 stages of renal failure (GFR in ml/min) and to the different dialysis techniques: hemodialysis, peritoneal dialysis, Continuous Renal Remplacement Therapy (CRRT).
- The maintenance doses for severe liver failure (Child-Pugh class B/C) and for mixed hepatorenal failure.
- A simplified indication (-, +, ++, +++) about detoxification possibilities with an extracorporeal technique (hemodialysis, CRRT, Charcoal hemoperfusion, plasmapheresis).
Figure 4: Card screen
Adjustments of the maintenance dose are done by changing the dosage and/or by changing the interval between every dose, depending on the pharmacodynamic and pharmacokinetic properties of the drug. It is also based on practical modalities, especially for dialysis patients (ex IV injections post dialysis). The proposed maintenance dosages are presented as the extreme range of dose and extreme range of administration frequency, all similar indications envisaged. So, the clinician has to refine the dosage while taking into account the characteristics of his patient (age, gender, weight, etc…) and the specific medical indication.
The proposed dosages are based the EMA and FDA approved monographs, and on the most recent medical and pharmaceutical literature.
When no data are available and in the absence of a strict contra-indication, the proposed dosages are based on a detailed pharmacodynamic and pharmacokinetic analysis of the drug and/or on the experience of the authors (this is mentioned with «!!!» ).
Proposed dosages are intended for adults and may not be applicable for paediatric use!
The adjusted dosages are intended for subjects with chronic stable renal failure. Acute kidney injury is excluded except for the oligo-anuric dialysed patient for whom dialysis doses may be proposed. When the patient is recovering from acute kidney injury, no standard recommendation may be done.
It is possible to search by therapeutic class by clicking on the corresponding checkbox in the list screen as well as in the card and info screens. This function is useful for a rapid search for a new molecule within the same therapeutic class (for example when a first search resulted in a contra-indication).
The second page of each record contains complementary information (Figure 5):
- Brand names for more than 30 countries in the world.
- A summary of physicochemical, pharmacokinetic and toxicological properties
- Specific scientific references (More than 20 000 in the entire database)
Figure 5: Info screen.
The software is translated in 4 languages (French, English, German and Dutch)
Drugs of topical use (dermatology, ophthalmology, aerosols…) and vaccines are yet not included because their use is merely not different from non uremic patients.
Keep in mind that “killed vaccines” can be administered in double dosages while the “live” ones are sometimes prohibited due to renal failure immunodeficiency.
Some specific tabs are also available on the toolbar:
The database was created and is being updated by a team of 5 nephrologists, 2 infectiologists and 1 clinical pharmacist. The IT management is exerted by a team of computer specialists.
A personalized dose, renal function and liver function calculator is proposed, based on individual biochemical and biometric data, for a precise categorization of each patient (Figure 6). Through an intelligent algorithm, the personalised stage of IRC is automatically determined.
Figure 6: Calculator, data screen.
A mobile version for Smartphone and Tablet, simplified for easy reading, is available. From a mobile device, the user is automatically directed to this version. It can return at any time on the basic version by selection the "Quit mobile mode" tab, then return to mobile mode by selection the "Mobile mode" tab of each respective version.
The major advantages of Renadaptor© are its accessibility and its ease to use.
All efforts are being made to assure accurate and complete information but no guarantee is given in this field. This tool has no other ambition than being a help for clinicians, while prescribing drugs to renal failure patients.
Brand names are only mentioned in order to help searching for a drug in the database. Despite efforts to be exhaustive, the correspondence between the brand name and the molecule (INN) is not fully guaranteed.
The authors, the editor and all the suppliers of the present database cannot be held responsible if therapeutic or other accidents would occur, nor can they be held responsible for all possible consequences due to the use or non-use of the software and its contents.
1994-96 : Writing by Dr. Luc Radermacher (nephrologist) of a "Practical guide for hemodialysis", a textbook for assistant in nephrology at the University Hospital of Liège in Belgium. Chapter 25: "Pharmacological Adjustment to Renal Failure and Dialysis"; contains 400 medicines processed on Excel spreadsheet.
1997 : Creation of a booklet "Pharmacological adaptations to renal failure and extra-corporeal purification techniques". 200 copies, containing the Excel file of the 400 molecules of the practical guide, are published with the help of GlaxoWellcome, and distributed in hospitals in the Liège region.
2000 : Association with a computer scientist (Mr Georgios Dracoulis). Creation of the first database on CD-ROM, in FileMaker format, always containing the 400 original molecules updated. Name given: Adaptor.
2006: Enlargement of the Adaptor database to 600 molecules, and new denomination: Renadaptor. Medical team with 4 internists (3 nephrologists: Drs. Luc Radermacher, Xavier Warling, Martial Moonen and 1 infectiologist: Dr Eric Firre - CHR of Liège / Citadelle). Translation in 4 languages (French, English, German and Dutch).
2009 : Creation of the first Internet version of Renadaptor ( www.renadaptor.net ), still in FileMaker format. Copyright "RenAdaptor". Enlargement of the database to 800 molecules. Several presentations for doctors and clinical pharmacists in Belgian hospitals. Death of Mr Georgios Dracoulis and resumption of the IT function by Mr Ivon Hixon.
2010 : Internet version in PHP format. Expansion of the database to 1000 molecules. Constitution of the company sprl Medicinformatic and legal framework (DBB association of lawyers - Mons). Poster presented at the congress of the French Society of Nephrology in Brussels.
2012 : Sponsorship by the french speaking nephrologists association of Belgium (GNFB). Expansion of the database to 1300 molecules.
2013 : Expansion of the database to 1400 molecules.
First "Kidneys & Drugs" symposium in Liège.
2014: HONcode certification (HONConduct354525). Expansion of the database to 1500 molecules. Expansion of the IT team to 2 computer scientists: Mrs Ivon Hixon and Rachid Bimaghra.
Second "Kidneys & Drugs" symposium on the theme of cardiovascular treatments.
2015 : Creation of a calculator for personalized doses, renal function and liver function.
Third "Kidneys & Drugs" Symposium on the theme of infectious diseases.
2016 : Creation of a mobile version for Smartphone and Tablet. Expansion of the database to 1700 molecules.
Fourth "Kidneys & Drugs" Symposium on the theme of pain management.
2017 : ATC encoding. Expansion of the scientific team to 5 nephrologists (Dr. Luc Radermacher, Xavier Warling, Martial Moonen, Catherine Masset and Martina Milicevic), 2 infectiologists (Dr. Eric Firre and Dr. Filip Moerman) and a clinical pharmacist (Mr. Blaise Delhauteur).
Fifth Symposium "Kidneys & Drugs" on the theme of new targeted therapies in oncology.
2018 : Development of a second Internet version with complete redefinition of graphic outlines. Creation of a medical secretary position, for the systematic re-reading and standardization of the syntax of the records, ATC encoding, ....
Sixth "Kidneys & Drugs" symposium on the topic of the right prescription in geriatrics.
2019 : The second version of Renadaptor becomes active on February 15th at www.renadaptor.org , www.renadaptor.com , or www.renadaptor.be : Expansion of the database to 1900 molecules. Creation of a News window divided into 4 categories: "Company", "Drugs", "Scientific" and "Presentations".
Seventh "Kidneys & Drugs" Symposium on gastroenterology drugs.
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