Drug Utilization Evaluation Study and Dose Adjustment in Patients with Kidney Disease in Tertiary Care Hospital

Abstract

INTRODUCTION: Kidney disease is becoming a worldwide public health problem with an increase in incidence and prevalence, poor outcomes and high cost. Rational prescription is necessary in kidney disease patients. These patients are at higher risk of developing drug related problems since they need complex therapeutic regimens that include comorbid conditions like diabetes mellitus, hypertension, coronary artery disease and infection that require frequent monitoring and dosage adjustment. Inappropriate use of medications can increase adverse drug effects, which can be reflected by excessive length of hospital stays, excessive health care utilization and cost. OBJECTIVES: The objective of the study was to assess, evaluate and analyze the prescribing pattern of drugs in kidney disease and their dose adjustments in medicine and emergency department of tertiary care teaching hospital. METHODOLOGY: The study was conducted for a period of 6 months. Ethical clearance was obtained from Institutional Ethical Committee of S C S College of Pharmacy, Harapanahalli. Collected data was analyzed to identify the current prescribing trend and dosage regimen in the management of renal failure patients and to know whether the prescribing rationality was obtained in Medicine and Emergency unit in hospital by using KDIGO guidelines. RESULTS: A total of 140 patients were enrolled in the study according to the inclusion criteria in which 104 were males and 36 were females. 134 CKD cases and 6 AKI cases were found. In the study, 105 (75%) patients were hypertensive, 62 (44.28%) patients were anemic, 54 (38.57%) patients were diabetic and dyslipidemia was associated with 21 (15%) patients. 87 patients were on hemodialysis. On the basis of ATC classification of drugs, cardiovascular system (35.7%) class of drugs was the commonly prescribed followed by drugs for alimentary tract and metabolism (25.97%), anti-infective (10.11%) and blood and blood forming agents (7.97%). Out of 1028 studied drugs, only 105 (10.21%) required dose adjustment where 76 (72.38%) were adjusted and 29 (27.61%) were not adjusted. CONCLUSION: This study illustrates the need for proper dose adjustment and drug utilization pattern in patients with renal failure. Appropriate dosing of antibiotics as well as other drugs, including narrow therapeutic drugs play a vital role in preventing dose related adverse reactions and toxicities. This study will provide an outline for management strategies and will influence the decision making process in clinical practice.