Frequency, types and predictors of drug therapy problems among non-dialysis chronic kidney disease patients at a tertiary care hospital in Pakistan

Abstract

BackgroundDrug therapy problems (DTPs) are common among patients suffering from chronic kidney disease (CKD). However, there is a lack of information about DTPs and its predictors among CKD patients from Pakistan.ObjectivesTo evaluate the frequency, type and predictors of various types of DTPs among CKD patients at a tertiary-care hospital in Pakistan.MethodologyThis was a cross-sectional study carried out at Sandeman Provincial Hospital, Quetta between 1-11-2020 and 31-1-2021. It included 303 non-dialysis ambulatory patients of CKD-stage 3 and above. Cipolle et al., criterion was used for classifying the DTPs and a clinician at the study site checked the identified DTPs for accuracy. Data were analyzed by SPSS 23. Multivariate analysis was conducted to find the predictors of individual types of DTPs. A p-value <0.05 was considered statistically significant.ResultsThe patients received a total of 2265 drugs with a median of eight drugs per patient (range: 3–15 drugs). A total of 576 DTPs were identified among 86.1% patients with a median of two DTPs (interquartile range 1–3) per patient.Dosage too high(53.5%) was the most common DTP followed byadverse drug reactions (ADRs)(50.5%) andneed of additional drug therapy(37.6%). In multivariate analysis, patients’ age of >40 years emerged as a predictor ofunnecessary drug therapyanddosage too high. The odds ofneeding a different drug productwas significantly high in patients with cardiovascular diseases (CVD) and diabetes mellitus (DM). Thedosage too lowhad significant association with CVD. The risk ofADRswas significantly high in elderly patients (>60 years) and those with CVD. The presence of hypertension, DM and CKD stage-5 emerged as predictors ofdosage too high.ConclusionThis study revealed a high prevalence of DTPs among CKD patients. Targeted interventions in high risk patients may reduce the frequency of DTPs at the study site.