DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20190659

Analysis of prescription pattern of antihypertensives in various stages of chronic kidney disease

Prabitha P., Reshmi T., K. P. Jayakumar

Abstract


Background: Chronic kidney disease (CKD) is an emerging health problem and is one of the major causes of mortality. Hypertension is closely linked with CKD and both these conditions cause severe cardiovascular events. Hence blood pressure control is pertinent in all stages of CKD. This plays a major role in preventing its progression to end stage kidney disease and death. The objectives of the study were to analyse the class, dosing schedule of antihypertensive prescribed in Chronic Kidney Disease and the incidence of monotherapy and combination therapy.

Methods: This study designed as a cross sectional study was conducted in Nephrology department of a tertiary care center and antihypertensive prescription pattern of 364 CKD patients was analyzed. Demographic details, the co-morbid factors and the details of drugs received by each patient were recorded from their outpatient/ inpatient charts. Data collected were entered in MS excel sheet and descriptive analysis done using SPSS software.

Results: Calcium Channel Blocker (CCB) was the most commonly prescribed antihypertensive (70.6%) in all stages and the most common CCB was Cilnidipine (54%) with the dosing schedule of 20mg twice daily (56.4%). Incidence of combination therapy was 71.7% and CCB+AA (Alpha agonist) was the commonest combination prescribed in all stages except stage 1.

Conclusions: CCBSs were widely prescribed as antihypertensive in CKD irrespective of the stages. Cilnidpine was the routinely prescribed CCB and seemed to be well tolerated by the patients. The protocol followed in this tertiary care center was in accordance with the standard guidelines by Kidney Disease Improving Global outcomes 2012.


Keywords


Cilnidipine, Hypertension, Kidney disease improving global outcomes guidelines, Renal failure

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References


Webster AC, Nagler AV, Morton RL, Masson P. Chronic kidney disease. Lancet. 2017;389(10075):1238-52.

Varma PP. Prevalence of CKD in India - Where are we heading? Indian J Nephrol. 2015;25(3)133-5.

Tozawa M, Iseki K, Iseki C, Kinjo K, Ikemiya Y, Takishita S. Blood pressure predicts risk of developing ESRD in men and women. Hypertension. 2003;41:1341-5.

Bakris GL, Ritz E. The message for world kidney day2009: hypertension and kidney disease: a marriage that should be prevented. Clin J Am Soc Nephrol. 2009;4(3):517-9.

Lettica Buffet, Charlotte Richetti. CKD and Hypertension a destructive combination. US Pharm. 2012:37(6):26-9.

The Renal Association. CKD stages. Available online at https://renal.org. Accessed on 15 November 2018.

Priya BB, Basavanna PL. Pattern of antihypertensive drug utilization among CKD patients in a dialysis unit of tertiary care hospital. IJBR. 2015;6:2455-6.

Iseki k. Gender difference in chronic kidney disease. Kidney Int. 2008;74(4):415-7.

Carrero JJ, Hecking M, Chesnaye NC, Jager KJ. Sex and gender disparities in the epidemiology and outcomes of chronic kidney disease. Nat Rev Nephrol. 2018;14(3):151-64.

Center for disease control and prevention. Chronic kidney disease surveillance system risk factor and theme: Age. Available at: https://nccd.cdc.gov. Accessed on 15 November 2018.

Kidney international supplements. Blood pressure management in CKD ND patients with diabetes mellitus. 2012;2(5):323-69.

Joseph N, Yogananda R, Bharathi. A study on prescription pattern of antihypertensive agents in chronic renal failure patients and assessment of medication adherence. Int J Pharm Sci Rev Res. 2017;45(2):72-5.

Ahmad R, Habib A, Rehman S. management of hypertension in patients with end stage renal disease leading to hemodialysis: a challenge. IJAM. 2016;3(4):790-8.

Uchida S, Takahashi M, Sugawara M, Saito T Nakai K, Fujita M, et al. Effects of N/L type calcium channel blocker Cilnidipine on nephropathy and uric acid metabolism in hypertensive patients with chronic kidney disease (J-CIRCLE study). J Clinhypertens (Greenwich). 2014;16(10):746-53.

Shete MM. Cilnidipine: Next generation CCB. J Assoc Physicians India. 2016;64:95-9.