Prescribing patterns and drug dosage adjustment in patients undergoing chronic haemodialysis at dialysis centres in Windhoek, Namibia
Loading...
Date
2024
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
University of Namibia
Abstract
Patients with End Stage Renal Disease (ESRD) are in chronic kidney disease stage 5 with
a Glomerular Filtration Rate of <15 ml/min/1.73m2
. These patients have a high burden of
co-existing diseases. Consequently, they may take as many as six or more different drugs
to manage these conditions. The use of many medicines by these patients puts them at
significant risk of drug-related problems. The aim of the study was to investigate
prescribing patterns and explore appropriateness of drug therapy among ESRD patients
undergoing regular haemodialysis at dialysis centers in Windhoek. This was a quantitative
cross-sectional analytical study involving the review of clinical records of patients with
ESRD on maintenance haemodialysis at two dialysis centers in Windhoek. A total of 147
patients’ clinical records were reviewed and included in this study, 53.7% were males and
46.3% were females. More than half of the patients (53.1%) were state funded while
46.9% were privately funded patients. The mean age of the participants was 47.3±15.1
years. The majority of patients had between 3 to 4 comorbidities, with the most common
co-morbid conditions being hypertension, anaemia, diabetes mellitus, secondary
hyperparathyroidism and venous thromboembolism. A total of 163 different drugs were
prescribed to all patients, with an average of 11.50 (±3.5) drugs per patient. The most
common drug classes prescribed were cardiovascular drugs (38.3%) followed by
alimentary tract and metabolism drugs (25.6%) as well as drugs for blood and blood
forming organs (23.1%). Medications were appropriately selected in 80.3% of the
patients, while the remaining 19.7% had at least one or more inappropriately selected
drugs. Out of the total prescription entries, 15.6% required renal dosage adjustment,
48.7% of those that required adjustment were appropriately adjusted while 51.3% were
inappropriately adjusted. For the inappropriately adjusted entries, 21 (15.6%) prescription
entries were underdosed, 111 (82.2%) were overdosed, treatment duration was
inappropriately long for 3 (2.2%) entries. 18.0% of the patients had all (100%) of their
medications appropriately renally adjusted while 82.0% had at least one or more
inappropriately renally adjusted drugs. The number of drugs prescribed was significantly
associated with medication choice errors, while increasing age unexpectedly increased the
likelihood of appropriate dosage adjustment. In conclusion, patients with ESRD on
haemodialysis were being managed with a relatively large number of drugs and although
ii
the drugs were appropriately selected for their indications in most cases, the dose was not
appropriately adjusted
Description
A thesis submitted in partial fulfilment of the requirements for the Degree of Master of Pharmacy (Clinical Pharmacy)
Keywords
Haemodialysis, Chronic kidney disease, Renal dosage adjustment, Drug selection