Drug therapy problems and quality of life in patients with chronic kidney disease

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Date
2008
Authors
Mahmoud, Mansour Adam
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Abstract
Drug therapy problems (DTP) are a significant challenge to health care providers that are associated with morbidity, mortality and patient's quality of life (QoL). Patients with chronic kidney disease (CKD) receive a wide range of pharmacotherapeutic agents and are therefore at higher risk to experience DTP. To date, DTP in hospitalized CKD ~\ patients have not been investigated in Malaysia. Thus, this study was aimed to assess DTP and to evaluate QoL using SF-36 instrument in CKD patients. A prospective observational study was conducted among 308 patients with CKD who were aged 18 years or older and admitted to the general medical ward of Penang General Hospital (PGH). Of this, 154 patients had confirmed diagnosis of end stage renal disease (ESRD) (ESRD group) and 154 patients had the diagnosis of stage one to stage four of CKD (non- ESRD group). Out of the 154 ESRD patients initially followed in the study, four patients took discharge at their own risk and three patients died in the medical ward during the follow-up. On the other hand, of the 154 non-ESRD patients, two patients absconded from the medical ward and three patients took discharge at self risk. Hence, data with complete information were available for 14 7 ESRD patients and 149 non-ESRD patients. DTP were identified through review of patients' medical charts and patients interviews. DTP were categorized into eight: indication without drug (IWD), drug without indication (OWl), improper drug selection (IDS), inappropriate dosage adjustment, adverse drug reactions (ADR), drug interactions (01), inappropriate laboratory monitoring and patient's non-adherence. While, patients' QoL was assessed using a validated and self XX administered SF-36 QoL questionnaire. Statistical Package for Social Science (SPSS) version 12 was used for data analysis. Chi-square test, Fisher's exact test, correlation coefficient and linear regression analysis were used wherever appropriate and P-value <0.05 was considered as statistically significant. The mean age of patients was 53 ± 15.3 years and 48.9 ± 17.9 years for the ESRD and the non-ESRD groups, respectively. ESRD pati~nts had more DTP than non-ESRD patients {P<0.001). The most common DTP among the ESRD patients were: IWD (20.9%), IDS (20.7%) and Dl (19.4%) whereas, among the non-ESRD group, the most common DTP were: IWD (20.3%), DI (19.0%), and IDS (18.0%). Increased age, female gender, duration of hospitalization and duration of CKD were found to be significantly associated with the number of DTP. In addition, hypertension, coronary heart disease (CHD), number of drugs, antihypertensive drugs and anaemia drugs were also found to be associated with number of DTP. QoL evaluation revealed that ESRD patients had significantly lower QoL than their non-ESRD counterparts (P<0.001). Factors such as increased age, Indian or other race, number of comorbidities, creatinine cleatal}ce, ADRs, anti-infective drugs, dialysis, duration of CKD were found to be associated with a lower QoL (P<0.05).
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Chronic kidney
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