Prescribing pattern of medicines in chronic kidney disease with emphasis on phosphate binders

Abstract

Objectives:Patients with chronic kidney disease (CKD) suffer with multiple comorbidities and complications like secondary hyperparathyroidism and hyperphosphotemia. Altered mineral metabolism contributes to bone disease and cardiovascular disease. In patients of CKD, despite dietary phosphorus restriction, phosphate binders (PBs) are recommended to control phosphorous level. No studies about the utilization pattern of PBs in CKD patients have been reported from India. This study analyses the current prescribing trends in the management of CKD patients undergoing tertiary care with focus on PBs.Materials and Methods:This cross-sectional, observational study was conducted in nephrology department of a government super speciality hospital over 8-month period from January to August 2011. Demographic, clinical, and medication details were collected in a specially designed proforma.Results:A total 111 prescriptions were included in the study. Average number of drugs per prescription was 9.47. About 41.53% of the prescribed drugs were from the World Health Organization essential medicines list. Out of total prescribed drugs (1052), most commonly prescribed were vitamins and minerals (24.71%), cardiovascular drugs, (22.14%), and hematopoietic agents (20.15%). Considering individual drugs, five most commonly prescribed drugs were multivitamins (14.82%), iron (8.65%), folic acid (8.55%), calcium carbonate (8.17%), and calcitriol (5.60%). A total of 11.02% of prescribed drug were PBs. Among PBs, calcium carbonate was the most frequently prescribed and sevelamer was the least prescribed PB. No patient was prescribed lanthanum carbonate.Conclusion:This study identified a wide variety of drug classes including PBs prescribed in CKD patients. Although sevelamer hydrochloride has less side effects as compared to calcium salts, it was less prescribed since it is costlier.

Drug utilization study in OPD of a tertiary care hospital in a rural area of Jalna, Maharashtra, India by using WHO prescribing indicators

“…But implementation of this practice of prescribing by generic names is not always satisfactory and requires motivation of prescribers and strong regulatory interventions. 13 The result of the present study showed that the percentage of encounters with an antibiotic prescribed was found to be 60%. In several other studies, it was seen that percentage of encounters with antibiotic was 78.15%.…”

“…7 Encouraging prescriptions by generic names is always recommended by various national and international bodies to promote rational use of drugs. 13 The drugs if prescribed by generic name also gives the advantage to the pharmacist to dispense the cheaper drugs to the patients, this helps to reduce the economic burden on patients. Also this practice will certainly help to check the luring practices if offered by some of the pharmaceutical companies to the practitioners for promoting their costlier brands.…”

Assessment of Quality of Life and Drug Usage Among Haemodialysis Patients at A Tertiary Care Hospital

“…[22] In study done by Bajait CS et al, 55% were hypertensive and 31% were diabetic patients, which was lower than our study where it was 84 % (hypertension) and 34.5% (diabetes mellitus). [23] Polypharmacy or use of more than 5 or more drugs at a time is an unavoidable predicament faced while managing CKD patients due to the prevalence of co-existing illnesses. The…”

Drug utilisation study in medicine outpatient department at Ashwini Rural Medical College, Kumbhari, Solapur, India

“…10 Encouraging prescriptions by generic names is always recommended by various national and international bodies to promote rational use of drugs. 11 The drugs if prescribed by generic name also gives the advantage to the pharmacist to dispense the cheaper drugs to the patients, this helps to reduce the economic burden on patients. Also, this practice will certainly help to check the luring practices if offered by some of the pharmaceutical companies to the practitioners for promoting their costlier brands.…”

“…But implementation of this practice of prescribing by generic names is not always satisfactory and requires motivation of prescribers and strong regulatory interventions. 11 WHO has defined "Essential medicines are those that satisfy the priority health care needs of the majority of population. 6 In the present study, results showed that the percentage of drugs prescribed from essential drug list was (60.22%), analysis was done with reference to Tripathi KD.…”