Assessment of medication related problems among patients with chronic kidney disease in Kenyatta National Hospital

Abstract

Background: Medication related problems are real or potential medical conditions associated with medication use that could result in undesired health outcomes. Patients with chronic kidney disease are prone to medication related problems due to the complexity of their medication regimens. Objective: The study aimed at identifying and characterizing medication related problems among patients with chronic kidney disease in Kenyatta National Hospital, Kenya. Methodology: A cross-sectional study was carried out among conveniently sampled, 60 adult patients with chronic kidney disease stage 3 and 4. Medication related problems were identified and classified according to Hepler and Strand classification (1990). Data were analysed using R statistical programming language. Descriptive summary statistics were presented as means with standard deviation, frequencies and percent proportions. Multivariate logistic regression models were constructed to investigate the associations between the stage of chronic kidney disease and the individual medication related problem while adjusting for possible confounding by other covariates. The odds ratios, the 95% confidence intervals of the odds ratio, and the associated p-values of all the univariate and multivariate models were reported. Variables were considered significant if the odds ratio p-value ≤ 0.05. Results: There was a female preponderance at 56.7% and the mean age was 54±16.8 years. The mean number of comorbidities and prescribed drugs per participant was 4.9±1.8 and 9.3±3.3 respectively. We identified 271 medication related problems and their mean number per participant was 4.5±1.4. Commonest problems were drug interactions (21.8%), indication without drug (18.1%) and failure to receive drug (15.5%). Compared to patients with chronic kidney disease stage 3, patients with chronic kidney disease stage 4 were 5.9 times more likely to have an improper drug selection problem (p = 0.01) and 4.7 times more likely to experience an over-dosage problem (p = 0.01). For a unit increase in the number of medications per prescription, the odds of having a drug without indication increased by 1.33 (95% CI, 1.11 to 1.67, p= 0.01) and the odds of failure to receive drug increased by 1.27 (95% CI, 1.05 to 1.59, p = 0.02). In addition, the odds of having sub-therapeutic dosage increased by 1.27 (95% CI, 1.06 to 1.59, p = 0.02) for a unit rise in the number of drugs prescribed. Conclusion: Prevalence of medication related problems among patients with chronic kidney disease is high. Most occurring problems were drug interactions, indication without drug and failure to receive drug. Several types of problems were significantly associated with number of medications per prescription. To address these problems we advocate for healthcare providers to actively look out for medication related problems among patients with chronic kidney disease who inevitably are prescribed many drugs.