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N.Vanitha Rani, Rini Thomas, Rohini E, P. Soundararajan G. Kannan,
P. Thennarasu


Background: Chronic Kidney Disease (CKD) is a progressive condition with an increase in drug usage, resulting in increased prevalence of actual and potential drug related problems (DRPs) in these patients, posing significant challenge to health care providers. Objective: The aim of the study was to identify drug related problems in patients with chronic kidney disease (stages I to V), to resolve them by providing interventions to the health care providers and to educate the patients regarding the drug therapy. Methodology: A study was conducted in 226 patients (159 (70.4 %) males and 67 (30%) females), aged 18 years or older, diagnosed with all stages of Chronic Kidney Disease and hospitalized, including patients on maintenance hemodialysis and post renal transplantation. Patients data were collected by direct history interview and from the patient medical records, the prescriptions were analyzed and the DRPs were identified and classified and pharmacist intervention was done as per the simplified Iaser methodology. Descriptive analysis was done for age, drugs and DRPs and Kendall’s taub non-parametric test was used to assess the correlation between drugs prescribed and DRPs. All statistical tests were two tailed and P<0.05 was used to indicate statistical significance. Results: The average number of drugs per prescription was found to be 8.93 + 3.26. A total of 184 (81%) of DRPs were identified in 226 patients with an average of 0.81+0.896 DRPs per prescription. The number of DRPs was found to be increasing with an increase in number of drugs per prescription. The common drug related problems found in the study were drug-drug interactions in 40.2% patients which included 11(4.8%) severe, 79 (34.9%) moderate and 2 (0.88 %) minor interactions; non-compliance in 38.2 % patients and treatment duplicity in 5 patients (2.2%). The main reasons for non-compliance were found to be lack of adherence to recommendation (11.1%), lack of understanding to therapy (14.66%), difficulties for administration (5.33%) and economic reasons (7.11%). Interventions were made at the prescriber level for drug interactions and treatment duplicity and at the patient level to resolve non-compliance by educating them on their drug therapy. Conclusion: Continual identification, intervention and resolution of drug related problems in CKD could play a vital role in achieving better clinical outcomes.

Keywords: Drug related problems, hemodialysis, adherence, chronic kidney disease.

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