Evaluation of Drug-Related Problems in the Chronic Kidney Disease Clinic at the University Hospital in Thailand

Abstract

Background: The chronic kidney disease (CKD) clinic plays a vital role in providing comprehensive ambulatory care for patients with CKD. Pharmacists contribute to ensuring proper drug use and identifying potential drug-related problems (DRPs). However, the evaluation of DRPs in the early phase of CKD clinic, particularly in resource-limited countries, remains limited. Objective: This study aimed to assess the prevalence of DRPs in CKD patients attending a CKD clinic, investigate the associated drug categories, and identify factors contributing to DRPs in CKD patients. Methods: A cross-sectional study was conducted from January 2020 to June 2021 among CKD patients attending a CKD clinic. Patient information records were used to collect demographic and relevant CKD data. A checklist for DRPs related to CKD progression and complications was utilized. Eight categories of unmet DRPs were examined. Multiple linear regression was used to investigate the relationship between pre-defined factors and the number of DRPs per patients. Results: The study included 80 patients with a total of 1,073 prescribed medications. The mean age was 73.1 ± 10.0 years, and the mean estimated glomerular filtration rate (eGFR) was 43.4± 12.9 mL/min/1.73 m². A total of 269 DRPs (25.1% of prescriptions) were identified, primarily involving the need for additional drug therapy (14.9%), dosage too high (6.3%), and inappropriate drug therapy (1.5%). Notably, renin-angiotensin-aldosterone system (RAAS) blockers were frequently omitted when indicated. NSAID use, non-compliance, and drug interactions were notable issues. The significant predictor of DRPs was the number of medications more than 7 items (ß = 0.258, P = 0.02). Conclusions: Implementing medication optimization in CKD care involving multidisciplinary teams and pharmacists is essential. Our study highlights the importance of ACEIs/ARBs, dosage adjustments, avoiding nephrotoxic agents, addressing non-compliance, and managing drug interactions for improved CKD care. The study identifies polypharmacy as a significant predictor of DRPs among CKD patients, facilitating targeted interventions for at-risk patients.