Abstract
Introduction: Multiple comorbidities and altered pharmacokinetics are common in patients with CKD, which can have long-lasting consequences on quality of life.[1,2] Understanding the nature of medication prescribed for co-morbidities, and the monitoring they require, is essential for safe prescribing practice and to avoid drugrelated problems (DRPs) in CKD. Objective: This study aims to describe the drug utilisation patterns of in-hospital CKD patients, with reference to the World Health Organisation (WHO) drug use indicators.[3] Methods: An observational follow up study on the drug utilisation pattern was conducted in hospitalised CKD patients over five months (November 2021 to April 2022) in a large teaching hospital in England. The study included hospitalised patients > 18 years with CKD and followed them until discharge. WHO core drug use indicators were evaluated. Prescribed drugs for each patient were recorded on a data collection tool prepared for the purpose of this study and all drugs were classified according to the Anatomical Therapeutic Chemical (ATC) Classification System. Polypharmacy (> 6 drugs) risk factors were assessed with univariable and multivariable logistic regression using STATA 17 Software. Results: During the study period, 387 patients were included in this study, with mean (SD) age of 75 (± 15.5). Over half were female (n = 208 54%). The mean (SD) number of drugs per patient was 11 (± 4.9), the percentage of patients requiring a prescription of an antibiotic was 61.8%, the percentage of patients requiring a prescription of an injection was 93.5%, the percentage of drugs prescribed by generic name was 90.2%, and the percentage of drugs prescribed from essential drugs list or formulary was 88.9%. The most frequent drug groups prescribed were: Alimentary tract and metabolism (22%), Cardiovascular system (18.7%), and Blood and blood forming organs (17%). Longer hospital stay (P < 0.001), admission to a renal ward (P = 0.02) and number of comorbidities (P < 0.001) were independently associated with polypharmacy. Conclusion: In this cohort of CKD patients, we found mixed compliance with the WHO drug use indicators. There was relatively good compliance with drug formulary use and with generic prescribing, but a high number of drugs prescribed. As might be expected more complex patients with longer stays, and multiple co-morbidities had a higher chance of polypharmacy with the potential for increased DRPs. Further work should investigate prescribers' views on prescribing in CKD patients.