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Background Chronic kidney disease (CKD) is a challenging global health problem with increasing prevalence worldwide. Concurrence of CKD and comorbidities results in the use of multiple medications and exposing patients to polypharmacy. Polypharmacy in CKD is common across all the stages of the disease and leads to poor medication adherence, higher healthcare costs, and drug-related problems, such as drug-drug interactions (DDIs) and adverse drug reactions (ADRs). DDIs and ADRs in CKD patients may lower the quality of life, increase the length of hospital stay, and augment the risks of morbidity and mortality. Methodology This was a hospital-based, prospective, cross-sectional study conducted in a secondary care hospital. The study population comprised 130 adult CKD patients admitted to the nephrology department including those on maintenance hemodialysis. Study-related data were obtained from the electronic patient case records. Medications prescribed to the patients were analyzed for potential DDIs (pDDIs) using Portable Emergency and Primary Care Information Database (PEPID 12.1) drug interaction checker. All observed and reported suspected ADRs related to the prescribed drugs were evaluated for causality, severity, preventability, and predictability. Results Out of the 130 patients, majority were males (n = 71, 54.6%), in the age group of 61-70 years (n = 45, 34.6%), and belonged to CKD stage 5 (n = 105, 80.8%). The mean number of drugs prescribed was 11.1 ± 3.8 per patient. The prevalence of pDDIs was found to be 89.2%. Upon analysis by the PEPID database, 708 pDDIs with 215 different pairs of interacting drugs were identified. Polypharmacy (odds ratio (OR): 62.34, 95% confidence interval (CI): 7.97-487.64, p < 0.001) was identified as an independent predictor of the occurrence of pDDIs. Negative binomial regression analysis revealed that dyslipidemia (incidence rate ratio (IRR): 2.7, 95% CI 2.09-3.48, p < 0.001) and diabetes (IRR: 1.2, 95% CI 1.01-1.54, p = 0.040) increased the probability of occurrence of pDDI by 2.7 and 1.2 folds, respectively. Furthermore, the likelihood of pDDI increased with every one-day increase in the length of hospital stay (IRR: 1.02, 95% CI 1.00-1.03, p = 0.015) by 1.02 times and polypharmacy (IRR: 6.30, 95% CI 3.04-13.02, p < 0.001) by 6.3 times. The incidence of ADRs was found to be 10.7%. Majority of suspected ADRs were possible (n = 7, 50.0%), of mild and moderate severity (n = 7, 50.0%), and non-preventable (n = 8, 57.1%) type. Conclusions This study investigated two important drug-related problems, pDDIs, and ADRs, in the CKD population. High proportion of CKD patients in the study had pDDIs. Comorbid conditions such as dyslipidemia and diabetes mellitus, length of hospital stay, and polypharmacy were significantly associated with increased likelihood of pDDIs. Furthermore, there was a burden of ADRs in the study population, of which most ADRs were possible and of mild to moderate severity. Prevention, identification, and resolution of these problems in CKD patients is important and can be achieved through medication optimization, which requires a proactive interdisciplinary collaboration between clinicians, clinical pharmacists, and other healthcare professionals.
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OBJECTIVE: To evaluate the patterns of drug use and polypharmacy burden in patients with chronic kidney disease (CKD). MATERIALS AND METHODS: It was a prospective observational cohort study done in a secondary care hospital in Ras Al Khaimah, United Arab Emirates (UAE). 130 CKD patients admitted under the care of nephrology in-patient department including those undergoing regular maintenance hemodialysis were included in the study. Electronic patient case records of CKD patients were studied and analyzed to evaluate drug use pattern and medication burden. RESULTS: The majority of the study patients were in CKD stage G5 (82.3%, 107/130). The median number of different drugs prescribed per patient was found to be 11.0. Negative binomial regression analysis revealed that CKD patients with more than 4 comorbidities were prescribed 1.27 times more than patients with ≤ 4 comorbidities (IRR: 1.273, p = 0.017). Patients with dyslipidemia (IRR: 1.393, p < 0.001) and hyperphosphatemia (IRR: 1.189, p = 0.048) as comorbid conditions were more likely to be prescribed a higher number of drugs than patients without these comorbid conditions. With every 1-day increase in length of hospital stay, the likelihood of drug prescription also increased 1.01 times (IRR: 1.01, p = 0.040). Multivariate logistic regression analysis identified older age (OR:1.07, p = 0.004), higher number of comorbidities (OR: 9.58, p = 0.011), comorbid conditions like dyslipidemia (OR: 43.7, p = 0.001), and hyperphosphatemia (OR: 17.18, p = 0.044) as independent predictors of polypharmacy in our study population. CONCLUSION: The study represents the current drug use pattern among CKD patients in a secondary care hospital in UAE. Study findings highlight that medication burden in CKD patients was high, and the majority of them were on polypharmacy.