Drug-drug interactions (DDIs) are common in clinical practice and are directly related to factors such as polypharmacy, aging, hepatic metabolism and decreased renal function. Individuals with chronic kidney disease (CKD) often require multiple classes of drugs being at important risk for the development of DDIs. The objectives of this study were to identify the drug-drug interactions in CKD patients admitted to medicine ward in KIMS Hospital & Research Centre, and to categorize the drug-drug interactions based on their severity. The prescriptions of 108 patients who fulfilled inclusion criteria of study were analyzed during the study period to determine drug-drug interactions (DDIs). Out of total patient included in the study, in 78 patients medical record, 388 DDIs has been found during patient`s medical record analysis. On correlating between patient`s age group and DDIs it has been found that most number of recorded DDIs, 33 patients (30.56%) were belong to age group between 51-70 years. DDIs has been classified into serious, significant and minor. Out of total 388 DDIs, 57 (14.96%), 220 (56.7%) and 111 (28.61%) were serious, significant and minor DDIs respectively. Among all prescribed drugs, diuretics were among drugs with highest number of DDIs followed by antihypertensive agents, hypoglycemia agents and antithrombotic agents respectively. In relationship between polypharmacy and DDIs the highest number of patients, 48 (44.44%) have been received 13-17 medications. Patients with renal insufficiency are at high risk of drug-drug interactions, especially in the later stages of the disease. Monitoring patient`s medication chart by clinical pharmacist to detect DDIs early can improve quality of patient health care and provide appropriate mechanism for management of drug therapy among CKD patients.

Homocysteine is an amino acid that is produced by the body and it can be converted into methionine or cysteine with the aid of B-vitamins and tetrahydrofolate. Renal function is a major determinant of plasma homocysteine concentration, and patients with chronic renal failure have severe hyperhomocysteinemia. The aim of study was to determine the effect of high doses of folic acid, vitamin B6 and B12 to reduce the homocysteine levels in chronic kidney disease patients. In present study, 60 renal failure patients fulfilled study criteria. These 60 patients, were divided into two groups of which 30 were selected into control and 30 were recruited in sample. The average of Hcy levels before starting treatment was obtained 31.14 umol/L. After treating patient with folic acid, vitamin B6 and B12 for a period of 3 months the average serum homocysteine level was measured and resulted 27.43 umol/L. Our study showed decrease and/or improve in average level of serum homocysteine among end stage renal failure and chronic kidney disease patients who have been received folic acid and vitamin B6 and B12 supplements, compared with controls. Risks due to increased homocysteine causes heart disease, stroke, peripheral vascular disease, diabetes. Our study concludes that high doses of folic acid, vitamin B6 and B12 treatment has improved or decreased the levels of Hcy in patients with renal failure, which in turn has reduce the risk of cardiovascular complications. This will improve quality of life of patients and decreases the mortality rate due to cardiovascular disorders.

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