Assessment of prescribed medications and pattern of distribution for potential drug–drug interactions among chronic kidney disease patients attending the Nephrology Clinic of Lagos University Teaching Hospital in Sub-Saharan West Africa

Abstract

IntroductionLife expectancy has increased significantly among chronic kidney disease (CKD) patients due to the extensive use of polypharmacy practice for medication prescriptions. This predisposes them to potential drug–drug interactions (DDIs), which can lead to an increase in morbidity, mortality, length of hospital stay, and health care cost.MethodsThis was a 30-month retrospective study that reviewed the medical case records of consenting adult CKD patients from January 2014 to June 2016. The Medscape drug reference database was used to evaluate patients’ medications for potential DDIs.ResultsThis study involved 123 adult CKD patients (63 [51.22%] males and 60 [48.78%] females) with a mean age of 53.81±16.03 years. The most common comorbid conditions were hypertension (112 [91.10%]) and diabetes mellitus (45 [36.60%]). Regarding the form of nephrological interventions being offered, the majority of the respondents - 66 (53.66%) were on maintenance dialysis, followed by 53 (43.09%) respondents on conservative care, while 4 (3.25%) respondents were on renal transplantation. A total of 1264 prescriptions were made, and the mean number of prescribed medications per patient was 10.28±3.85. The most frequently prescribed medications were furosemide (88 [71.6%]), heparin (67 [54.47%]), lisinopril (65 [52.9%]), oral calcium carbonate (CaCO3) (63 [51.2%]), α-calcidol (62 [50.4%]), and erythropoietin (61 [49.6%]). A total number of 1851 potential DDIs were observed among 118 patients. The prevalence of potential DDIs in this study was 78.0%, while the mean DDI per prescription was 1.50. Among the potential DDIs observed, the severity was mild in 639 (34.5%) patients, moderate in 1160 (62.7%) patients, and major in 51 (2.8%) patients and only 1 (0.1%) patient was of contraindicated drug combination. The most frequent DDIs’ pattern observed was between oral CaCO3 and oral ferrous sulfate. There was a statistically significant association between the number of prescribed medications and the estimated glomerular filtration rate (eGFR; pre-ESRD and ESRD staging) with a P-value of 0.00000119. This implies that the number of prescribed medications increases as the eGFR declines in advance CKD stage patients.ConclusionMost of these interactions have moderate severity and delayed onset, hence the need to follow-up these patients after prescription in order to reduce associated morbidity, mortality, length of hospital stay, and health care cost. Physicians and clinical pharmacists should utilise available interaction software to avoid harmful DDIs in these patients.

Prevalence of Potential Drug–Drug Interaction Risk among Chronic Kidney Disease Patients in a Spanish Hospital

“…Table 7 shows previous reports in which the prevalence and severity of pDDIs has been evaluated on CKD patients. It is remarkable that there are two studies published in 2017 that were carried out in different hospitals in Nigeria, with different numbers of individuals, but their results are practically identical despite using different analysis tools [ 17 , 18 ].…”

“…Previous studies have evaluated the prevalence and severity of potential drug–drug interactions (pDDIs) using different drug–drug interaction programs among CKD patients from Brazil [ 10 , 11 ], India [ 12 , 13 ], Pakistan [ 14 ], Palestine [ 15 ], and Nigeria [ 16 , 17 , 18 , 19 ]; however, there are no published studies evaluating the prevalence of pDDIs among CKD patients in any European country.…”

Impact of Adverse Drug Reactions in Patients with End Stage Renal Disease in Greece

“…Another consideration should be made for potential interactions with CNS drugs such as alprazolam that can enhance the PD effects of the drug in those patients [41,42]. Generally, CNS and CVD medications (including statins and anti-platelet, anticoagulant drugs) can be the possible or probable reason for ADE/ADRs in the current population, as also estimated from the Naranjo scale results ( Figure 5) [43][44][45].…”

Potential drug-drug interactions in acute ischemic stroke patients at the Neurological Intensive Care Unit

“…A study of only 79 such patients showed that the frequency of pDDIs at discharge from the general neurological department was 72% [15], while in patients with stroke (ischemic and hemorrhagic), the prevalence of pDDIs was 61%-89.5% [7,8]. The highest frequency of pDDIs (98% for highly significant interactions), was observed in patients from the ICU among antimicrobial drugs [16], and 95.9% in patients with CKD [17]. A review about the prevalence of pDDIs showed that their frequency was 67% in the ICU and 33% in general departments [1].…”