Evaluation of drug-drug interactions among patients with chronic kidney disease in a South-Eastern Nigeria tertiary hospital: a retrospective study

Abstract

IntroductionThe risk of drug-drug interactions (DDIs) is high in patients with chronic kidney disease (CKD) necessitating dose adjustments or the avoidance of drug combinations. This study aimed to evaluate DDIs among patients with CKD in the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria.MethodsThis study was a retrospective review of patients with CKD who received treatment at the nephrology unit of UNTH between January 2004 and December 2014. The drug-drug interactions (DDIs) of the prescribed drugs were classified using the RxList interaction checker. The IBM SPSS Version 21.0 was utilized for statistical analysis with P-value ≤ 0.05, considered statistically significant.ResultsA total of 749 DDIs were identified from the folders of the 169 patients with CKD that were eligible. Majority were above 50 years old and in stage 4 or 5 CKD. Furosemide, lisinopril and amlodipine were the most frequently prescribed drugs and had the greatest likelihood for nephrotoxicity. The number of medications and hypertension (as co-morbidity) were significant and independent predictors of DDIs among the patients. About 70% of the drug combinations required monitoring as they fell within the “significant category” of the RxList interaction checker. The most common interactions were between lisinopril and furosemide; furosemide and calcium carbonate; lisinopril and calcium carbonate.ConclusionThe prevalence of DDIs was high among the CKD patients. Prescribers and pharmacists in Nigerian hospitals may need to pay close attention to prescriptions of patients with CKD to identify, prevent and resolve undesirable DDIs.

Prevalence of Potential Drug–Drug Interaction Risk among Chronic Kidney Disease Patients in a Spanish Hospital

“…Previous studies have evaluated the prevalence and severity of potential drug–drug interactions (pDDIs) using different drug–drug interaction programs among CKD patients from Brazil [ 10 , 11 ], India [ 12 , 13 ], Pakistan [ 14 ], Palestine [ 15 ], and Nigeria [ 16 , 17 , 18 , 19 ]; however, there are no published studies evaluating the prevalence of pDDIs among CKD patients in any European country.…”

Review of Impact and Handling of Potential Antihypertensive Drug Interactions in Chronic Kidney Disease Patients

“…The average number of the drugs combination used reported from the 10 articles was 5 to 15 drugs therapy used per patient (Adibe et al, 2017;Busari et al, 2019;Chinwendu et al, 2017;Fasipe et al, 2017;Marquito et al, 2014;Okoro & Farate, 2019;Olumuyiwa et al, 2017;Raddad et al, 2016;Rama et al, 2012;Santos-Díaz et al, 2020). Then, several studies also reported that the number of potential drug interactions that occurred is significantly associated with the number of drugs used by the patients (Adibe et al, 2017;Chaliks, 2015;Chinwendu et al, 2017;Okoro & Farate, 2019;Saleem et al, 2017;Santos-Díaz et al, 2020). Thus, polypharmacy is the contributed factor to the drug interactions, in which the more drug therapy used by the patient, the bigger the risk of drug interaction experienced by CKD patients.…”

“…Based on the review from selected ten research articles, it is known that combination therapy used in the treatment of CKD patients with the most prominent to cause drug interaction is from combination with antihypertensive drugs (Adibe, Ewelum, & Amorha, 2017;Busari et al, 2019;Chinwendu et al, 2017;Ghanbari & Nagaraju, 2016;Marquito et al, 2014;Okoro & Farate, 2019;Olumuyiwa et al, 2017;Raddad et al, 2016;Saleem et al, 2017). Three other articles note that drug interactions also involve the antihypertensive drug classes, but the antihypertensive drug classes in these articles are not the cause of most drug interactions ( Fasipe et al, 2017;Rama et al, 2012;Santos-Díaz et al, 2020).…”

“…Several drug classes in Table 3 showed that the diuretic drug class becomes the highest cause of drug interactions in CKD patients. The drug interactions could occur from irrational prescription so that the rational prescription could reduce polypharmacy as a contributed factor to drug interactions (Adibe et al, 2017).…”

“…c,e,f (Rama et al, 2012), a,b,c,d,g (Marquito et al, 2014 (Raddad et al, 2016), a,b,c,e,h (Saleem et al, 2017), a,b,c(Olumuyiwa et al, 2017), a,b,c (Fasipe et al, 2017), a,b,c,d,f(Chinwendu et al, 2017), a,b,c,d,f (Adibe, Ewelum, & Amorha, 2017), a,b,d,e (Busari et al, 2019 (Okoro & Farate, 2019), a(Santos-Díaz et al, 2020).…”