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Published on: October 2, 2020
Evaluation of Pharmacotherapeutic Patterns in Patients With Renal Impairment Undergoing Hemodialysis: A Drug
Dilip Kanjariya1, Anita Sinha1, Hardik Vaniya1
1Pharmacology, Government Medical College, Surat, Surat, IND.
Insights
This study on hemodialysis patients in India found high rates of hypertension and polypharmacy, with suboptimal use of generic and essential medicines. Findings highlight the need for rational prescribing and standardized pharmacotherapy in dialysis care.
Area of Science:
- Nephrology
- Pharmacology
- Public Health
Background:
- Chronic kidney disease (CKD) and acute kidney injury (AKI) are major global health concerns.
- India faces a growing burden of CKD, exacerbated by hypertension and diabetes, with limited renal replacement therapy access.
- Hemodialysis patients encounter challenges with complex medication regimens and adverse drug reactions.
Purpose of the Study:
- To evaluate drug prescribing patterns in hemodialysis patients.
- To assess drug utilization against WHO prescribing indicators.
- To promote rational drug use in hemodialysis pharmacotherapy.
Main Methods:
- A 12-month cross-sectional observational study in Surat, Gujarat, India.
- Informed consent and data collection from 150 adult hemodialysis patients using a pre-designed case record form.
- Statistical analysis using IBM SPSS Statistics, Version 20.
Main Results:
- Hypertension (64.6%) and diabetes (24.6%) were leading comorbidities; 23% were unaware of their illness.
- Average prescription of 7.53 drugs per patient, with parenteral erythropoietin being common.
- Cardiovascular (29.8%) and gastrointestinal (20%) agents were most frequent; generic (60.17%) and NLEM (68.76%) prescribing rates were suboptimal.
Conclusions:
- Hemodialysis patients exhibit high prevalence of hypertension and polypharmacy, with significant use of cardiovascular and gastrointestinal drugs.
- Suboptimal generic and essential drug prescribing rates and high injection use were observed.
- Variations in drug utilization across healthcare settings necessitate rational prescribing and pharmacotherapy standardization.
Abstract:
Background Chronic kidney disease (CKD) and acute kidney injury (AKI) are significant contributors to renal morbidity and mortality worldwide. In India, the rising prevalence of hypertension and diabetes has led to an increase in CKD cases, with limited access to renal replacement therapies. Hemodialysis remains a common treatment modality, but patients face challenges, including complex medication regimens and adverse drug reactions. Drug Utilization Studies (DUS) are essential to evaluate prescribing patterns and promote rational drug use in this population. Methodology A cross-sectional observational study was conducted over 12 months at two setups in Surat, Gujarat, India. Ethical approval was obtained from the HREC. Adult patients (≥18 years) undergoing hemodialysis were enrolled after informed consent. Data were collected using a pre-designed case record form based on WHO core prescribing indicators. Statistical analysis was performed using IBM Corp. Released 2014. IBM SPSS Statistics for Windows, Version 20. Armonk, NY: IBM Corp. Result The study was conducted on 150 hemodialysis patients (64% male; mean age 46.5 ± 14.7 years). Most (116; 77.3%) received dialysis 2-3 times per week. Hypertension (97; 64.6%) and diabetes (37; 24.6%) were the leading comorbidities, while 35 (23%) were unaware of their illness. Parenteral medications were prescribed to 104 patients (69.3%), with erythropoietin being the most common (75; 50%). A total of 1130 drugs were prescribed, averaging 7.53 per patient. Out of the total drugs used, 680 (60.17%) were prescribed generically, and 777 (68.76%) were from the National List of Essential Medicines (NLEM). Among drug classes, cardiovascular agents were most frequent (337; 29.8%), followed by gastrointestinal (226; 20%) and hematopoietic agents (112; 12%). Significant differences in drug usage were observed between healthcare setups (p < 0.01). Conclusion The study reveals a high prevalence of hypertension and polypharmacy among hemodialysis patients, with significant reliance on cardiovascular and gastrointestinal drugs. Generic and essential drug prescribing rates were suboptimal, and injection use was notably high. Statistically significant differences in drug utilization patterns across healthcare setups underscore the need for rational prescribing and standardization of dialysis pharmacotherapy.
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