Archives of Medicine and Health Sciences (Jan 2018)
The burden of polypharmacy and pattern of comorbidities among chronic kidney disease patients in clinical practice
Abstract
Introduction: The practice of polypharmacy and pattern of associated specific comorbidities/complications among chronic kidney disease (CKD) patients can predispose them to drug-related problems such as drug–drug interactions (DDIs) and adverse drug reactions (ADRs) which may be associated with increased morbidity, mortality, health-care cost, and length and frequency of hospitalization. This can also produce a negative deteriorating and counter-efficient effect on the health and treatment outcome of these patients. Materials and Methods: This was a descriptive, prospective study of 18-month duration that was carried out to review the medical case records of consented adult CKD patients attending a Nigerian tertiary kidney care hospital from January 2015 to June 2016. Results: This study involved 123 consented adult CKD patients comprising 82 (66.67%) males and 41 (33.33%) females, with a mean age of 53.81 ± 16.03 years. The most frequently prescribed medications were furosemide (88, 71.6%), enoxaparin (67, 54.47%), lisinopril (65, 52.9%), oral calcium carbonate (63, 51.2%), α-calcidol (62, 50.4%), and erythropoietin (61, 49.6%). Among these CKD patients, the prevalence of polypharmacy and renal replacement therapy was 85.37% and 56.91%, respectively. Most proportion of the respondents 45 (36.59%) had two number of comorbidities with hypertension (103, 83.70%), diabetes mellitus (39, 31.70%), obesity (24, 19.51%), heart failure (11, 8.90%), obstructive uropathy (8, 6.50%), HIV (7, 5.70%), and stroke (5, 4.10%) being the most frequent. Regarding the form of nephrological interventions being offered: Majority of the respondents, i.e., 66 (53.66%), were on maintenance dialysis, followed by 53 (43.09%) on conservative care and 4 (3.25%) on renal transplantation. Conclusion: The prevalence of polypharmacy is significantly high in these CKD patients. The practice of polypharmacy and pattern of associated specific comorbidities can indeed increase the risk of drug-related problems such as DDIs and ADRs. There is a critical need to minimize the number of prescribed medicines for these patients in order to reduce the associated morbidity, mortality, healthcare costs, and frequency and length (duration) of hospitalization.
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