Adverse Drug Reactions Among Hospitalised Patients With Chronic Kidney Disease In Dubai Hospital: With Reference To Bleeding Tendency Among Hospitalised Patients
| dc.contributor.author | Sharif Askari, Fatemeh Saheb | |
| dc.date.accessioned | 2016-11-21T07:30:01Z | |
| dc.date.available | 2016-11-21T07:30:01Z | |
| dc.date.issued | 2014-08 | |
| dc.description.abstract | Chronic kidney disease (CKD) patients are particularly vulnerable to adverse drug reaction (ADR) because they usually are on multiple drug regimens, have different comorbid conditions, and because of alteration in their pharmacokinetics and pharmacodynamic parameters. The overall aim of this thesis was to evaluate and assess adverse drug reactions among hospitalized patients with moderate to severe CKD, and to develop an ADR risk score to identify and stratify CKD patients who are at increased risk of ADRs during hospital stay. To meet the objective of the thesis, a one year observational prospective study was conducted at the renal unit of Dubai Hospital, the United Arab Emirates. Consecutive patients with CKD stages 3 to 5 (estimated GFR, 10-59 ml/min/1.73 m2) who were admitted to the renal unit, between January 1, 2012, and December 31, 2012 were recruited. For each patient, data was collected at admission using a standardized form. An ADR risk score was developed by constructing a series of logistic regression models. The overall model fit for sequential models was compared using the Akaike Information Criterion. Odd ratios of the variables retained in the best model were used to compute the risk scores. Furthermore, a propensity score analysis was undertaken to examine the relation of anticoagulant use with adverse outcomes, and to test the protective effects of statin on the major bleeding events caused by anticoagulation therapy. Among hospitalised patients with CKD, at least 1 in 8 patients experienced an ADR during hospital stay; patients in ESRD who were not on any renal replacement therapy were at higher risk of developing an ADR; and, more than half of the total ADRs were bleeding events related to anticoagulants use. Major bleeding occurred in 1 of 3 patients who received anticoagulation therapy during hospital stay, and anticoagulant users were 3-times more likely to die when compared with those with no anticoagulation therapy; however, statin had a protective association with the anticoagulant-related bleeding events. Among hospitalised patients with CKD, there can be considerable heterogeneity in the risk for ADRs. By using the ADR risk score, higher-risk patients could receive more intensive interventions aimed at reducing the drug-related adverse outcomes and improving the cost-effectiveness of CKD therapy. Also, using this score, different risk levels could be used to triage patients for decision regarding the initiation of renal replacement therapy. Anticoagulation therapy in hospitalised patients with CKD was significantly associated with an increased risk of major bleeding and in-hospital mortality. Higher risk was observed in a range of patient groups and was not reduced after adjusting for the common cofounders. These results suggest that further preventive measures to reduce the number of death caused by anticoagulant is warranted. | en_US |
| dc.identifier.uri | http://hdl.handle.net/123456789/3132 | |
| dc.language.iso | en | en_US |
| dc.publisher | Universiti Sains Malaysia | en_US |
| dc.subject | Chronic kidney disease | en_US |
| dc.title | Adverse Drug Reactions Among Hospitalised Patients With Chronic Kidney Disease In Dubai Hospital: With Reference To Bleeding Tendency Among Hospitalised Patients | en_US |
| dc.type | Thesis | en_US |
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