Pattern of medication use and adverse drug reactions among chronic kidney disease patients attending the nephrology clinic of a tertiary hospital

Abstract

Background: Chronic kidney disease (CKD) is associated with many adverse health outcomes 1,2. Patients with CKD are often given several medications for the management of the disease, its attendant complications and other comorbidities. These drugs often have drug-drug interactions which increase the risk of adverse drug reactions (ADRs) that may lead to more frequent hospital visit/admissions. This will further worsen morbidity and mortality.

Objective: This study was carried out to highlight the additional risk that adverse drug reactions pose to the CKD patients in terms of morbidity and mortality.

Methods: A hundred and twenty patients with CKD in various stages (stage1-5) were studied. Data was collected using a structured questionnaire administered to participating patients after explanations had been made to them. Information on age, sex, types of medication, side effects of medications experienced by patient were obtained. The Glomerular filtration rate (GFR) was also calculated for each patient using the Cockroft-Gault and CKD-EPI formulae to stage the disease. The Naranjo algorithm was used to determine whether an adverse drug reaction is actually due to the drug rather than the result of other factors.

Results: Most patients (51%) were middle-aged and were on at least seven different medications. Common medications used included: Lisinopril (57%), Lorsartan (7%), Alpha methyldopa (9%), Atenolol (20%), Furosemide (46%), Simvastatin (18%), Calcium carbonate (35%), Nifedipine (32%), Moduretic (15%), and Alphacalcidol (15%). Using Naranjo scoring system, about 20% of the patients were found to have definite ADR, 34% probable ADR, 44% possible adverse drug reaction and 2% doubtful ADR.

Conclusion: This study shows that adverse drug reactions are common in CKD patient as up to 20% of patients had ADR. Therefore, physicians should look for ADR in CKD patients and treat appropriately.

Keywords: Multiple drug use, adverse drug reactions, chronic kidney disease