Evaluation of Pharmacotherapeutic Patterns in Patients With Renal Impairment Undergoing Hemodialysis: A Drug Utilization Study

TL;DR

This study examines medication use in Indian patients undergoing hemodialysis, finding high rates of polypharmacy and cardiovascular drug use with suboptimal generic prescribing.

Contribution

The study provides a detailed drug utilization analysis in Indian hemodialysis patients, highlighting prescribing patterns and variability across healthcare setups.

Findings

Most hemodialysis patients received an average of 7.53 drugs per patient.

Cardiovascular agents were the most frequently prescribed drug class.

Significant differences in drug usage were observed between healthcare setups.

Abstract

Background

Chronic kidney disease (CKD) and acute kidney injury (AKI) are significant contributors to renal morbidity and mortality worldwide. In India, the rising prevalence of hypertension and diabetes has led to an increase in CKD cases, with limited access to renal replacement therapies. Hemodialysis remains a common treatment modality, but patients face challenges, including complex medication regimens and adverse drug reactions. Drug Utilization Studies (DUS) are essential to evaluate prescribing patterns and promote rational drug use in this population.

Methodology

A cross-sectional observational study was conducted over 12 months at two setups in Surat, Gujarat, India. Ethical approval was obtained from the HREC. Adult patients (≥18 years) undergoing hemodialysis were enrolled after informed consent. Data were collected using a pre-designed case record form based on WHO core prescribing indicators. Statistical analysis was performed using IBM Corp. Released 2014. IBM SPSS Statistics for Windows, Version 20. Armonk, NY: IBM Corp.

Result

The study was conducted on 150 hemodialysis patients (64% male; mean age 46.5 ± 14.7 years). Most (116; 77.3%) received dialysis 2-3 times per week. Hypertension (97; 64.6%) and diabetes (37; 24.6%) were the leading comorbidities, while 35 (23%) were unaware of their illness. Parenteral medications were prescribed to 104 patients (69.3%), with erythropoietin being the most common (75; 50%). A total of 1130 drugs were prescribed, averaging 7.53 per patient. Out of the total drugs used, 680 (60.17%) were prescribed generically, and 777 (68.76%) were from the National List of Essential Medicines (NLEM). Among drug classes, cardiovascular agents were most frequent (337; 29.8%), followed by gastrointestinal (226; 20%) and hematopoietic agents (112; 12%). Significant differences in drug usage were observed between healthcare setups (p < 0.01).

Conclusion

The study reveals a high prevalence of hypertension and polypharmacy among hemodialysis patients, with significant reliance on cardiovascular and gastrointestinal drugs. Generic and essential drug prescribing rates were suboptimal, and injection use was notably high. Statistically significant differences in drug utilization patterns across healthcare setups underscore the need for rational prescribing and standardization of dialysis pharmacotherapy.

Figures