Drug Utilisation Pattern and Adverse Events in Patients with Chronic Kidney Disease Undergoing Maintenance Haemodialysis at a Tertiary Care Hospital of Odisha
Dr. P. Ansuman Abhisek,
Plot No. 23, Jaya Durga Nagar, Cuttack Road, Bhubaneswar, Odisha-751006, India.
Introduction: The number of patients receiving renal replacement therapy in the form of dialysis or transplant has been increasing in recent years. Increased frequency of monitoring due to complex therapeutic regimen and inappropriate use of drugs may lead to increased Adverse Events (AEs), hospital stay, cost of treatment as well as increased morbidity and mortality.
Aim: To analyse utilisation pattern of drugs and AEs in Chronic Kidney Disease (CKD) patients undergoing maintenance haemodialysis.
Materials and Methods: This prospective, observational study was conducted in the Department of Pharmacology in collaboration with Department of Nephrology, SCB Medical College and Hospital, Cuttack, from 1st June to 31st December, 2015. Demographic, clinical and medicine details were collected from patientsâ€™ case sheet, matched with nursing case records and tabulated in a predesigned case study form. The data were analysed in a descriptive manner using percentage calculation and SpearmanÂ´s correlation, multiple logistic regression using trial version SPSS v24.
Results: A total number of 115 cases were included in this study. Average number of drugs used, per prescription was 12.8 during the dialysis and non-dialysis days. Most frequently used drugs were antihypertensives, 25% dextrose and heparin (before dialysis and on dialysis days) were prescribed to all patients followed by haematinics in 90.43% of the patients and proton pump inhibitors were prescribed in 70.43% of the patients. Among 1472 drugs prescribed, 40.96% of the drugs were prescribed in generic name. It was observed that 72.62% of the prescribed drugs were from National List of Essential Medicine. AEs were observed with varying severity in all the patients. Frequently observed AEs as per the laboratory investigations were hyperphosphataemia, hyponatraemia, metabolic acidosis, hyperkalemia, hypoglycaemia, hypocalcaemia and hypokalemia. AEs were statistically significant with age group >45 years (p<0.001).
Conclusion: This study provides an insight regarding utilisation pattern of a wide variety of drug classes in CKD patients undergoing maintenance haemodialysis in a tertiary care teaching hospital setting and suggests a possible improvement in medicine practices among patients suffering from CKD which may probably affect adherence patterns positively. Certain areas like potential drug interactions, adverse drug reactions and adherence are required to be explored further.