Determinants and outcomes of hyperpolypharmacy among chronic kidney disease patients in a teaching hospital in Northern Ghana
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20261105Keywords:
Chronic kidney disease, Drug utilization pattern, Hyperpolypharmacy, Determinants, OutcomesAbstract
Background: There is paucity of drug utilization studies among patients with chronic kidney disease (CKD) patients in Ghana. This study aimed to evaluate drug utilization pattern focusing on prevalence of hyperpolypharmacy and its determinants and outcomes among CKD patients in a teaching hospital in northern Ghana.
Methods: A retrospective cross-sectional was conducted among patients with CKD patients in the Tamale Teaching Hospital (TTH).
Results: Drugs acting on the cardiovascular system were the most commonly utilized (n=639/2081, 30.7%). Majority of the CKD patients 107/198 (54.0%) utilized prescriptions with ≥10 drugs concurrently (i.e. hyperpolypharmacy). Patients with 3-4 and ≥5 comorbidities were 5.3 times (AOR=5.3, 95% CI: 1.39-20.30, p=0.015) and about 8-folds (AOR=7.9, 95% CI: 2.04-30.31, p=0.003) more likely to have hyperpolypharmacy respectively. Exposure to hyperpolypharmacy was significantly associated with potential drug-drug interactions; contraindicated (OR=6.3, 95% CI: 2.51-15.92, p<0.001), serious-use alternative (OR=3.2, 95% CI: 1.71-5.73, p<0.001), and monitor closely (OR=3.1, 95% CI: 1.75-5.98, p<0.001), exposure to hyperpolypharmacy resulted in 4-folds higher likelihood to stay >7 days hospitalization (AOR=4.1, 95% CI: 2.26-7.51, p<0.001).
Conclusions: The presence of three or more comorbidities was an independent determinant of hyperpolypharmacy. which was associated with adverse outcomes; increased severity of potential drug-drug interactions and longer hospitalization. Hence, clinicians of TTH need to implement measures to prevent hyperpolypharmacy among CKD patients to help mitigate its associated burden.
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References
Inker LA, Astor BC, Fox CH, Tamara I, James PL, Carmen AP, et al. KDOQI Commentary KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD. Am J Kidney Dis. 2014;63(5):713-35. DOI: https://doi.org/10.1053/j.ajkd.2014.01.416
Francis A, Harhay MN, Ong ACM, Tummalapalli SL, Ortiz A, Fogo AB. Chronic kidney disease and the global public health agenda: an international consensus. Nat Rev Nephrol. 2024;20(07):473-85. DOI: https://doi.org/10.1038/s41581-024-00820-6
Alemu H, Hailu W, Adane A. Prevalence of Chronic Kidney Disease and Associated Factors among Patients with Diabetes in Northwest Ethiopia : A Hospital-Based Cross-Sectional Study. Curr Ther Res. 2020;92:100578. DOI: https://doi.org/10.1016/j.curtheres.2020.100578
Adjei DN, Stronks K, Adu D, Beune E, Meeks K, Smeeth L, et al. Chronic kidney disease burden among African migrants in three European countries and in urban and rural Ghana: the RODAM cross-sectional study. Nephrol Dial Transplant. 2018;33(10):1812-22. DOI: https://doi.org/10.1093/ndt/gfx347
WHO. Introduction to Drug Utilization Research. World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland; 2003. Available at: https://www.who.int. Accessed on 25 January 2026.
Alruqayb WS, Paudyal V, Malcolm P. Drug utilisation study in hospitalised chronic kidney disease patients, using World Health Organisation prescribing indicators: an observational study. J Pharm Policy Pract. 2024;17(1):1-18.
Kamath L, Hema NG, Himamani S. A study of drug utilisation pattern in patients of chronic kidney disease at a tertiary care hospital. Int J Basic Clin Pharmacol. 2019;8(2):170-5. DOI: https://doi.org/10.18203/2319-2003.ijbcp20190131
Atic´ A, Škerlj JM, Juric´ I, Lea K, Vesna FČ, Marina K, et al. Factors Associated with Hyperpolypharmacy and Complex Medication Regimens in Kidney Transplant Recipients. J Clincal Med. 2024;13(13):3719. DOI: https://doi.org/10.3390/jcm13133716
Schmidt IM, Hu S, Nadal J, Stephanie T, Matthias S, Barbara B, et al. Patterns of medication use and the burden of polypharmacy in patients with chronic kidney disease : the German Chronic Kidney Disease study Kidney Disease study investigators. Clin Kidney J. 2019;12(5):663-72. DOI: https://doi.org/10.1093/ckj/sfz046
Cho HJ, Chae J, Yoon S heon, Kim D sook. Aging and the Prevalence of Polypharmacy and Hyper-Polypharmacy Among Older Adults in South Korea: A National Retrospective Study During 2010-2019. Front Pharmacol. 2022;13:866318. DOI: https://doi.org/10.3389/fphar.2022.866318
Oosting IJ, Colombijn JMT, Bots ML, Sophie L, Solène ML, Lotty H, et al. Original Investigation Polypharmacy in Patients with CKD A Systematic Review and Meta-Analysis. Kidney360. 2024;5(6):841-50. DOI: https://doi.org/10.34067/KID.0000000000000447
KDIGO. Harmonizing acute and chronic kidney disease de fi nition and classi fi cation: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference. Kidney Int. 2021;100(7):516-26. DOI: https://doi.org/10.1016/j.kint.2021.06.028
MDCALC. ChroKD-EPI Equations for Glomerular Filtration Rate. 2025. Available at: https;//www.mdcalc.com. Accessed on 15 January 2026.
Medscape. Medscape. WebMD LLC. 2023. Available at: https://www.reference.medscape.com. Accessed on 15 January 2026.
WHO/WHOCC. WHO Collaborating Centre for Drug Statistics Methodology, Guidelines for ATC Classification and DDD Assignment 2024. World Health Organization Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index 2024; 2024. Available at: https://www.whocc.no/atcdddindex/. Accessed on 15 January 2026.
Boima V, Tannor EK, Osafo C, Awuku YA, Mate-kole M, Davids MR. The Ghana Renal Registry-a first annual report. Afr J Nephrol. 2021;24(1):19-24. DOI: https://doi.org/10.21804/24-1-4545
Teuwafeu DG, Joseph NB, Mahamat M, Aristide N, Francois KF, Gloria A. Epidemiological and Clinical Profiles of Chronic Kidney Disease Patients Presenting for Emergency Hemodialysis : A Five-Year Retrospective Study in Two Dialysis Centres in Cameroon. Open J Nephrol. 2022;(12):75-86. DOI: https://doi.org/10.4236/ojneph.2022.121007
Bikbov B, Perico N, Remuzzi G. Disparities in Chronic Kidney Disease Prevalence among Males and Females in 195 Countries : Analysis of the Global Burden of Disease 2016 Study. Nephron. 2018;139(4):313-8. DOI: https://doi.org/10.1159/000489897
Bawah AT, Edufia F, Yussif FN, Adu A, Yakubu YA. Chronic kidney diseases among homeless and slum dwellers in Accra, Ghana. Pan Afr Med J. 2021;38(340). DOI: https://doi.org/10.11604/pamj.2021.38.340.27106
Osman AA, Omar NMS, Osman MM, Ali AM, Bashir AM. Pattern and outcome of renal diseases in hospitalized patients at a tertiary hospital in Mogadishu, Somalia. Ren Fail. 2024;46(2):9-11. DOI: https://doi.org/10.1080/0886022X.2024.2363588
Marino C, Ferraro PM, Bargagli M. Prevalence of chronic kidney disease in the Lazio region , Italy: a classification algorithm based on health information systems. BMC Nephrol. 2020;21:23:1-10. DOI: https://doi.org/10.1186/s12882-020-1689-z
Jatta JW, Serwaa D, Ayepola F. Characterization of patients with chronic kidney disease admitted at Edward Francis Small Teaching Hospital in the Gambia: a descriptive cross-sectional study. Pan Afr Med J. 2020;2(15):1-10. DOI: https://doi.org/10.11604/pamj-oh.2020.2.15.24352
Alssageer MA, Saad MM, Mosbah OM. Prevalence of comorbidities, polypharmacy and drug-related problems among hospitalized patients with chronic kidney disease. Mediterr J Pharm Pharm Sci. 2023;3(1):51-63.
Arora P. Chronic Kidney Disease. Medscape. 2024.
Alruqayb WS, Paudyal V, Malcolm P. Drug utilisation study in hospitalised chronic kidney disease patients, using World Health Organisation prescribing indicators: an observational study. J Pharm Policy Pract. 2024;3211:1-18. DOI: https://doi.org/10.1080/20523211.2024.2430436
Al-jabri MM, Shastry CS, Chand S. Assessment of Drug Utilization Pattern in Chronic Kidney Disease Patients in A Tertiary Care Hospital Based on Who Core Drug Use Indicators. J Glob Pharma Technol. 2019;11(09):1-9.
Mathew S V, Uttangi S, Noble D, Ravi M, Mathew SK, Venkatesh JS. Drug Utilization Evaluation Study and Dose Adjustment in Patients with Kidney Disease in Tertiary Care Hospital. Int J Biomed Eng Clin Sci. 2021;7(3):52-64. DOI: https://doi.org/10.11648/j.ijbecs.20210703.13
Hayward S, Hole B, Denholm R. International prescribing patterns and polypharmacy in older people with advanced chronic kidney disease: results from the European Quality study. Nephrol Dial Transpl. 2020;36:503-11. DOI: https://doi.org/10.1093/ndt/gfaa064
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(1):36-9. DOI: https://doi.org/10.4103/0253-7613.125163
Ahlawat R, Sanjay D, Tiwari P. Pharmaceutical Care & Health Systems Drug Utilization Pattern in Chronic Kidney Disease Patients at a Tertiary Care Public Teaching Hospital: Evidence from a Cross-Sectional Study. J Pharma Care Heal Sys. 2016;3(1):1-5. DOI: https://doi.org/10.4172/2376-0419.1000149
Sangeetha B, Thangamani S. Evaluation of Drug Utilization Pattern in Patients with Chronic Kidney Disease. Biosci, Biotech Res Asia. 2023;20(09):1065-71. DOI: https://doi.org/10.13005/bbra/3157
Mekonnen A, Redley B, Crawford K. Associations between hyper-polypharmacy and potentially inappropriate prescribing with clinical and functional outcomes in older adults. Expert Opin Drug Saf. 2022;21(7):985-94. DOI: https://doi.org/10.1080/14740338.2022.2044786
Kimura H, Tanaka K, Saito H. Association of Polypharmacy with Kidney Disease Progression in Adults with CKD. CJASN. 2021;16(12):1797-804. DOI: https://doi.org/10.2215/CJN.03940321
Adjeroh L, Brothers T, Shawwa K, Ikram M, A MAM. The association between polypharmacy and health-related quality of life among non- dialysis chronic kidney disease patients. PLoS One. 2023;12(e0293912):1-19. DOI: https://doi.org/10.1371/journal.pone.0293912
Tan K soon, Johnson DW. Managing the cardiovascular complications of chronic kidney disease. Aust Presciber. 2008;31(6):154-8. DOI: https://doi.org/10.18773/austprescr.2008.087
Cadieux RJ. Drug interactions in the elderly: How multiple drug use increase risk exponentially. Postgrad Med. 1989;86(8):179-86. DOI: https://doi.org/10.1080/00325481.1989.11704506
Wang K, Alqurain AA, Albaharnah M. The prevalence of polypharmacy and hyper-polypharmacy among middle-aged vs. older patients in Saudi Arabia: a cross-sectional study. Front Pharmacol. 2024;(06):1-15. DOI: https://doi.org/10.3389/fphar.2024.1357171
Briones-aranda A. Polypharmacy with Multi-Mechanism Drugs : A Hidden Risk for Drug Interactions and Adverse Effects. In: Polypharmacy and Inappropriate Medication Use. IntechOpen Limited 167-169 Great Portland Street, London, W1W 5PF, United Kingdom. 2025;1-30. DOI: https://doi.org/10.5772/intechopen.1013524
Fukuba N, Nishida M, Hayashi M. The Relationship Between Polypharmacy and Hospital-stay Duration : A Retrospective Study Study design. Cureus. 2020;(12(3):e7267. DOI: https://doi.org/10.7759/cureus.7267
Labi A k, Obeng-nkrumah N, Owusu E, Bjerrum S. Multi-centre point-prevalence survey of hospital- acquired infections in Ghana. J Hosp Infect. 2019;101(1):60-8. DOI: https://doi.org/10.1016/j.jhin.2018.04.019
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