Identifying Drug-Drug Interaction Among Chronic Kidney Disease Patients in Tertiary Care Hospital

Abstract

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.

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

“…More than half of the DDIs were ‘significant’, requiring close monitoring. This was similar to the results of another study where about 56.7% of the DDIs were significant [ 13 ]. Clinical pharmacists, as integral members of the health care team, have vital roles to play in the early detection of DDIs.…”

“…In this study, the mean age of patients with chronic kidney disease was approximately 51 years supporting earlier research works that pointed out older age as a risk factor for the occurrence of polypharmacy and the development of chronic kidney disease [ 1 , 13 ]. In an Indian study among CKD patients, most of the recorded DDIs occurred in patients between 51-70 years [ 13 ]. After the age of 40 years, the glomerular filtration rate declines by about 10 mL/min every 10 years [ 1 ].…”

“…The highest occurring co-morbidity was hypertension and patients with hypertension as a co-morbid state had higher risk of drug-drug interactions. Anti-hypertensives have been indicated with a high number of DDIs [ 10 , 13 ]. In a study among renal failure patients of the nephrology ward in a South Indian tertiary care hospital, calcium channel blockers and beta blockers constituted the major class of drugs involved in interactions [ 9 ].…”

“…Also, majority of the patients with stage G4 and G5 had the highest prevalence of the disease, probably because the early stage of CKD is usually asymptomatic thereby making the patients to report to the hospital when the disease has deteriorated to the later stages with symptoms. In the later stages of the disease, patients with renal insufficiency are at high risk of DDIs [ 13 ].…”

“…Renal function monitoring is recommended for patients using medicines that are nephrotoxic [ 1 ]. In addition, furosemide is a drug with a high likelihood of causing DDIs [ 13 ].…”