Adverse drug reactions among hospitalised patients with chronic kidney disease in Dubai hospital: with reference to bleeding tendency among hospitalised patients
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Date
2014-08
Authors
SHARIF ASKARI, FATEMEH SAHEB
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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
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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.
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Keywords
Drug Reactions , Kidney Disease