Drug-Related Problems and Pharmacist Interventions in Inpatients with Chronic Kidney Disease

Abstract

Studies report poor quality and break in the care of chronic kidney disease (CKD) patients due to complex pharmacotherapy, frequent dose changes and adherence issues. The addition of clinical pharmacists on the healthcare team will enable improved quality of care. The aim of the study is to characterize drug-related problems (DRPs) among CKD patients and intervene to improve patient outcomes. This prospective, interventional study was carried out in the admitted inpatients of a tertiary care hospital during the period October 2018 to May 2019. Patients admitted to inpatient wards of nephrology, medicine, surgery and orthopedics who was diagnosed with chronic kidney disease of any stage and etiology and who gave consent to participate were included in the study. Patients diagnosed with cancer and/or receiving chemotherapy, significant liver disease, as evidenced by Child-Pugh grades B and C, and those with substance abuse disorders were excluded from the study. A clinical pharmacist reviewed the patient treatment chart to identify drug-related problems and communicated appropriate suggestions or recommendations to the nephrologist or attending physician. Identified DRPs were categorized according to 'The Pharmaceutical Care Network Europe Foundation (PCNE) classification V 6.2. All DRPs and pharmacist interventions were documented appropriately. Among 833 patients included in the study, a total of 250 DRPs were identified from 245 patients. DRPs occurred at a rate of 1.02 per patient in the study population. The most common DRPs were adverse drug reactions (P2.1) (40.4%), followed by the effect of treatment not optimal (P1.2) (28%). The most common drug classes involved were antibiotics, tramadol, insulin, and oral antidiabetic drugs. Dose change and the new drug started were the most common interventions made. Pharmacists can make positive contribution in caring for patients with CKD.