Drugs-Induced QT Interval Prolongation among End-Stage Renal Disease Patients in Jordan

Abstract

Background In spite of high risk of mortality due to drug-induced QT interval prolongation (QTcP) usage among end stage renal disease patients (ESRD), no previous studies were conducted to assess medication safety of this drugs category among this vulnerable patients group. Objectives This study aimed to investigate the appropriateness and potential drug-drug interactions of QTcP-inducing drugs among ESRD patients in Jordan. Method This study was a cross-sectional retrospective study conducted in the outpatient clinics of 200 Jordanian healthcare facilities over three years (2017, 2018, and 2019) using Hakeem© database for data collection. CredibleMeds© was used to identify and categorise QTcP-inducing drugs. Drug-drug interactions and appropriateness of prescribing were assessed by Micromedex Drug Reax© software and a multidisciplinary committee, respectively. Results Of the 407 patients included, 954 drugs with risk of QTcP were dispensed; 618 (64.8%) had interactions with other drugs; 10.4% were major, 29.3% were moderate, and 60.3% were minor drug-drug interactions. Absence of major polypharmacy and co-morbidity decreased the odds of major drug-drug interactions by 61% (OR 0.61; 95% CI 0.23-0.97; p=0.02), and 72% (OR 0.72; 95% CI 0.44-1.23; p=0.04), respectively. After clinical evaluation, 17.6% of the dispensed drugs were considered inappropriate application, 12.9% were classified as inappropriate choice, and 26.4% were judged as inappropriate decision. Urology clinics were more likely to prescribe QTcP-inducing drugs based on inappropriate decision. Conclusion Major drug-drug interactions and dispensing medications with risk of QTcP based on inappropriate prescribing decisions for patients with ESRD were reported to be high in outpatient clinics in Jordan.