Prescribing pattern of drugs in chronic kidney disease patients on hemodialysis at a tertiary care hospital
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20171106Keywords:
CKD, Drug utilization, HemodialysisAbstract
Background: CKD (chronic kidney disease) is a general term for heterogeneous disorders affecting kidney structure and its function. It is defined as either kidney damage or a decreased glomerular filtration rate of less than 60 mL/min/1.73m2 for 3 or more months. Objective of present work is to study the drug utilization pattern in chronic kidney disease patients undergoing hemodialysis.
Methods: After taking the clearance and approval from the institutional ethics committee, a cross sectional prospective observational study conducted on chronic kidney disease (CKD) patients undergoing hemodialysis, in the department of nephrology, of Rajarajeshwari Medical College and Hospital, Bangalore. The data was analyzed descriptively.
Results: Study included 52 patients, among them 41 males, 11were females, with a mean age of 47.6yrs. In our study large number pt were suffering from hypertension (HTN) 88.46% (46), in them the calcium channel blocker (CCB) 08.48% (38) was most commonly prescribed anti hypertensive drug. Around 1/3 of pt suffering from diabetes mellitus (DM) 36.53% (19) most of these patients were treated with them treated with oral hypoglycemic agents (OHA), and less than half of pt treated with insulin01.56% (07). Other drugs like phosphate binders (calcium carbonate & acetate) used in 11.16% (50), aspirin in 08.70% (39), statins in 10.04% (45) pt were being most commonly prescribed drugs. Totally 448 drugs were prescribed In 52 pts Ie about 8.61 drugs / prescription, showing poly pharmacy.
Conclusions: Patients undergoing hemodialysis with CKD will be having multiple diseases associated, regular monitoring and counseling regarding these diseases and its complication may reduce the incidence of CKD and the mortality and morbidity associated. The poly pharmacy noted in the study found inevitable because of the multifactorial etiologiesinvolved and needful multi-interventional approach towards it.
References
Levey AS, Coresh J. Chronic kidney disease. Lancet. 2012;379:165-80.
National Kidney Foundation. KDOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Am J Kidney Dis. 2002;39:S1-266.
Bajait CS, Pimpalkhute SA, Sontakke SD, Jaiswal KM, Dawri AV. Prescribing pattern of medicines in chronic kidney disease with emphasis on phosphate binders. Indian J Pharmacol. 2014;46:35-9.
Couser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney Int. 2011;80:1258-70.
Fogarty International Centre. Global Burden of Disease for the Year 2001. By World Bank Region for Use in Disease Control. Priorities in Developing Countries, 2nd Ed, 2004. Available from: http://www.pic.nih.gov/dcpp/gbd.html.
Perico N, Remuzzi1 G. Chronic kidney disease: a research and public health priority. Nephrol Dial Transplant. 2012;27:iii19-26.
Veerappan I, Abraham G. Chronic kidney disease: current status, challenges and management in India. Available from: http://www.apiindia.org/medicine_update_2013/chap130.pdf
Jafar TH, Stark PC, Schmid CH. Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis. Ann Intern Med. 2003;139:244.
Rani NV, Thomas R, Rohini E, Soundararajan P, Kannan G, Thennarasu P. A study on drug related problems in chronic kidney disease patients of a tertiary care teaching hospital in South India. World J Pharmaceu Res. 2014;3:1403-17.
CO Alebiosu, OO Ayodele, A Abbas. Chronic Renal Failure at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Afr Health Sci. 2006;6(3):132-8.
Anding K, Gross P, Rost JM. The influence of uraemia and haemodialysis on neutrophil phagocytosis and antimicrobial killing. Nephrol Dial Transplant. 2003;18:2067-73.
Jaiswal S, Das R, Sharma S, Paudel P, Lamichhane SR. Bacteriological study of urinary tract infection in male patients undergoing dialysis due to chronic kidney disease in tertiary care hospitals in Nepal. J Life Sci. 2013;3(2):2249-8656.
Chaudhary A, Stone WJ, Breyer JA. Occurrence of pyuria and patients bacteriuria in asymptomatic
hemodialysis. Am J Kidney Dis. 1993;21:180-3.
RF¨unfst¨uck, Ott U, Naber KG. The interaction of urinary tract infection and renal insufficiency. International Journal of Antimicrobial Agents. 2006;72-77.
Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients: excessive length of stay, extra cost, and attributable mortality. JAMA. 1997;227:301-6.
Long CL, Raebel MA, Price DW, Magid DJ. Compliance with dosing guidelines in patients with chronic kidney disease. Ann Pharmacother. 2004;38:853-8.
Kappel J, Calissi P. Safe drug prescribing for patients with renal insufficiency. Can Med Assoc J. 2002;166:473-7.
Gabardi S, Abramson S. Drug dosing in chronic kidney disease. Med Clin North Am. 2005;89:649-87.
Manley HJ, Cannella CA, Bailie GR, Pater WL. Medication-related problems in ambulatory hemodialysis patients: A pooled analysis. Am J Kidney Dis. 2005;46:669-80.
Al-Ramahi R. Medication prescribing patterns among chronic kidney disease patients in a hospital in Malaysia. Saudi J Kidney Dis Transpl. 2012;23(2):403-8.
Bonk ME, Krown H, Matuszewski K, Oinonen M. Potentially inappropriate medications in hospitalized senior patients. Am J Health Syst Pharm. 2006;63:1161-5.
Fattinger K, Roos M, Verge`res P. Epidemiology of drug exposure and adverse drug reactions in two Swiss departments of internal medicine. Br J Clin Pharmacol. 2000;49:158-67.
Manley HJ, Garvin CG, Drayer DK, Reid GM, Bender WL, Neufeld TK et al. Medication prescription pattern in ambulatory hemodialysis patients: Comparison of USRDS to a large not for profit dialysis provider. Nephrol Dial Transplant. 2004;19:1842-8.
Singh AK, Farag YM, Mittal BV, Subramanian KK, Reddy SR, Acharya VN et al. Epidemiology and risk factors of chronic kidney disease in India-results from the SEEK (screening and early evaluation of kidney disease) study. BMC Nephrology. 2013,14:114.