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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Journal ISSN
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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).
Description
Keywords
Chronic kidney