Abstract
Introduction: A drug-related problem (DRP) is defined as "an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes".141 Patients with chronic kidney disease (CKD) are more susceptible to DRPs due to comorbidities and polypharmacy.[2,3] Objective: This study aimed to investigate the types, characteristics, severity, causes, most common involved drug classes, and risk factors for DRPs in hospitalised patients with CKD. Methods: A prospective follow up study was conducted in one of the largest teaching hospital trusts in England examining adults > 18 years with a diagnosis of CKD (stage 1-4) hospitalised in medical and renal wards from November 2021 to April 2022. This study reviewed patients' records, prescriptions, laboratory tests' results to identify DRPs. Identified DRPs were classified according to Pharmaceutical Care Network Europe (PCNE) v 9.0 classification system and assessed by an expert panel for severity and preventability. Potential risk factors of DRPs were tested using logistic regression statistical analysis. Results: Three hundred and seventy-eight patients were included in this study with a mean age of 74.1 and a median of 78 (IQR 67-87). Females represented 54% of the sample, with polypharmacy present in 86% of patients. A total of 375 DRPs were identified in 240 patients (64%) with an average prevalence of 1.56 per patient. Prevalence of DRPs was 0.4% in stage-1 CKD, 1.7% in stage-2 CKD, 55% in stage-3 CKD, and 42.9% in stage-4 CKD. Number of DRPs per patients ranged from 1 to 4 (IQR 1-2). Treatment effectiveness was the most frequent DRP type (215-57.3%), followed by treatment safety (157-41.9%), and other (3-0.8%). The severity of DRPs was minor (n = 56, 14.9%), moderate (n = 315, 84%), and severe (n = 4, 1.1%). Most DRPs were definitely preventable (n = 268-71.5%). Common drugs groups involved were: Blood and blood forming organs (n = 88, 19.8%), Alimentary tract and metabolism with (n = 78, 17.6%), and Cardiovascular system with (n = 61, 13.7%). Hospital stays over 5 days and using > 6 drugs were independent factors for DRPs in CKD hospitalised patients with (OR 6.5, 95% CI 3.2-13.2; P = < 0.001) and (OR 6.3, 95% CI 2.9-13.5; P = < 0.001), respectively. Conclusion: The majority of hospitalised CKD patients experienced a DRP, with polypharmacy and co-morbidities as significant risk factors. Awareness of this increased risk should inform prescribing decisions. Future work should focus on interventions to reduce DRPs in patients with CKD.