POS-362 PRESCRIPTION PATTERN OF MEDICINE IN EARLY CKD STAGES IN ICKD COHORT STUDY

Abstract

Chronic kidney disease (CKD) is associated with multiple susceptibility and initiation factors. Therefore, multiple medications are required to retard disease progression and treatment of comorbidities at different stages of CKD. Several medical and non-medical factors affect the prescription. There are a few studies on the prescription pattern of medicines from LMIC countries. We aimed to study the prescription pattern in early CKD stages 1-4. The Indian chronic kidney disease (ICKD) is an ongoing prospective, nationwide, multicentric longitudinal cohort study that has recruited 4056 subjects aged 18-70 years with early stage of CKD (Stage 1-4) from 11 different tertiary care institute in India. Stable patients were recruited. Patients with Stage 5 CKD and those on dialysis were excluded. We analyzed the baseline data to find out the prescription pattern at different stages of CKD. Data of 3966 subjects with complete prescriptions were analyzed Mean age of subjects were 50.3 years, 67% were males. The mean eGFR as 40.48 ml/min/1.73m2, median annual income1680 USD, and 27 % were uneducated. Main etiology of CKD includes chronic interstitial nephritis (23.18%), diabetic kidney disease (24.93%), and chronic glomerulonephritis (14.75%). 19% had CKD of unknow cause. In terms of co-morbidities hypertension was seen in 70.52%, diabetes (35.24%), anemia (64.68%) and CVD (15.5%). The number of pills prescribed per patient was 5 (3, 6) {median (IOR)} with ≥3 in 28 %, 4-5 in 40% and 5-10 in 31% of subject. The different categories of medications at various stages of CKD are shown in table 1. 59% subjects with proteinuria and 56 % diabetic subjects were taking ACE/ARB. 92 % of CKD subjects with hypertension were taking antihypertensive drug with more than half (54%) receiving calcium channel blocker. 25 % of diabetic subject were on metformin and 57 % were receiving statins. Use of calcium-based phosphate binder was 41% in subject with serum phosphate level>4.5 mg/dl. Sodium bicarbonate therapy was seen in less than 55% of the patients, Statin in less than 42% and Vitamin D analogues in less than 13 % of subjects at all stages of CKD. Table 1Prescription pattern across CKD stages in ICKD cohortDrugsCKD STAGE-1(N=100)CKD STAGE-2(N=309)CKD STAGE-3(N=3131)CKD STAGE-4(N=421)Total (N=3961)ANTI-HYPERTENSIVE DRUGS89 (89)256 (82.85)2,525 (80.65)335 (79.57)3,209 (80.91)ANTI-DIABETIC DRUGS13 (13)57 (18.45)802 (25.61)87 (20.67)959 (24.18)PHOSPHATE BINDERS36 (36)119 (38.51)1,090 (34.81)207 (49.17)1,455 (36.69)IRON SUPPLEMENTS21 (21)64 (20.71)820 (26.19)139 (33.02)1,045 (26.35)ERYTHROPOIESIS STIMULATING AGENTS1 (1)9 (2.91)79 (2.52)22 (5.23)112 (2.82)SODIUM BICARBONATE11 (11)92 (29.77)1,367 (43.66)229 (54.39)1,700 (42.86)ANTI-PLATELET THERAPY8 (8)53 (17.15)707 (22.58)91 (21.62)860 (21.68)URIC ACID LOWERING AGENT3 (3)37 (11.97)498 (15.91)60 (14.25)598 (15.08)STATINS27 (27)110 (35.60)1,312 (41.90)152 (36.10)1,602 (40.39)VITAMIN D3 COMPOUNDS10 (10)17 (5.50)387 (12.36)54 (12.83)469 (11.83)MULTI-VITAMIN5 (5)50 (16.18)845 (26.99)146 (34.68)1,047 (26.40) Open table in a new tab Pills burden in patients with CKD was high. ACE inhibitors are relatively less prescribed than other anti-hypertensives.