Drug-Related Problems in Hospitalised Patients with Chronic Kidney Disease: A Systematic Review

Abstract

Introduction:Globally, Chronic Kidney Disease (CKD) is one of the leading causes of mortality.Impaired renal function makes CKD patients vulnerable to drug-related problems (DRPs). AimThe aim of this systematic review was to investigate the prevalence and nature of DRPs among hospital in-patients with CKD. MethodsA systematic review of the literature was conducted using Medline, EMBASE, PsycINFO, Web of Science (Core Collection), CINAHL plus (EBSCO), Cochrane Library (Wiley), Scopus (ELSEVIER) and PubMed (U.S.NLM) from index inception to January 2020. Studies investigating DRPs in hospitalised CKD patients published in English language were included. Two independent reviewers extracted the data and undertook quality assessment using Joanna Briggs Institute (JBI) tool. ResultsA total of 2895 unique titles were identified; with 20 meeting the inclusion criteria.DRPs prevalence in CKD was reported between 12% to 87%. The most common DRPs included ineffective treatment, inappropriate drug choice, and dosing problems.Antibiotics, H2-antihistamine and oral antidiabetics (metformin) were common drug classes involved in DRPs. Factors associated with DRPs included severity of CKD, the number of medications taken, age, length of hospital stay, and gender. ConclusionThis systematic review provides evidence that DRPs are a frequent occurrence and burden for hospitalised patients with stage 1-4 CKD. Heterogeneity in study design, case detection and definitions are common, and future studies should have use clearer definitions and study designs.

Frequency, types and predictors of drug therapy problems among non-dialysis chronic kidney disease patients at a tertiary care hospital in Pakistan

“…Therefore, CKD patients treated with several heterogeneous medications to halt the progression of CKD and minimize complications [3][4][5]. The impaired renal function, presence of co-morbidities, polypharmacy, dose adjustment needed for various drugs and older age make CKD patients a high risk group for occurrence of drug therapy problems (DTPs) [2,6,7]. A DTP is a gap between the prescribed therapy and the one needed to achieve the desired therapeutic outcomes [8].…”

“…Examples of DTPs include unnecessary drug therapy, need of additional drug therapy, need of a different drug product, dosage too low, adverse drug reaction, dosage too high and non-adherence [2,8]. The presence of DTPs not only interferes with the desired therapeutic outcomes, but also results in increased morbidity, hospitalizations, mortality, and health care costs [5,7,9,10]. In the published literature, the prevalence of DTP among CKD patients ranges from 55.9-100% [2,[11][12][13][14][15][16].…”

Education Standards for Pharmacists Providing Comprehensive Medication Management in Outpatient Nephrology Settings

“… 1 Medication regimens in patients with chronic kidney disease (CKD) become increasingly complex as the disease progresses and contribute to the high costs of care and CKD-related morbidity. 2 , 3 , 4 , 5 , 6 Medication reconciliation and management by pharmacists reduces medication therapy problems and 30-day readmissions in patients with CKD. 3 , 5 , 7 , 8 , 9 Integration of pharmacists into the multidisciplinary kidney transplant team has also led to improved medication safety.…”

“…2 , 3 , 4 , 5 , 6 Medication reconciliation and management by pharmacists reduces medication therapy problems and 30-day readmissions in patients with CKD. 3 , 5 , 7 , 8 , 9 Integration of pharmacists into the multidisciplinary kidney transplant team has also led to improved medication safety. 10 , 11 , 12 , 13 , 14 …”

“…[2][3][4][5][6] Medication reconciliation and management by pharmacists reduces medication therapy problems and 30-day readmissions in patients with CKD. 3,5,[7][8][9] Integration of pharmacists into the multidisciplinary kidney transplant team has also led to improved medication safety. [10][11][12][13][14] Pharmacists can offer more advanced care through comprehensive medication management (CMM), a patient-centered process of optimizing medications that is delivered by a pharmacist collaborating on an interprofessional team to improve health outcomes.…”