Introduction
QT interval prolongation (QTcP) is a congenital or acquired cardiac
condition that is associated with potential risks of torsade de pointes
(TdP) and sudden cardiac death (SCD) (1). The prevalence of acquired
QTcP is high and escalates with the decline in kidney function among
chronic kidney disease patients (CKD) who were reported to be suffering
from progression to end-stage renal disease (ESRD) which needing
emergency care (2,3,12,4–11). For each 1 mg increase in serum
creatinine, the QT interval prolongs by an average of 2.9 ms (5). A
previous study reported that the risk for QTcP is 2.47 times higher in
ESRD patients, than in CKD3 patients, and this may be attributed to the
impairment in drug disposition of renal excreted drug-induced QTcP (1).
Due to the complexity of drug pharmacokinetics in patients with CKD and
because many CKD patients are often prescribed drug-induced QTcP, renal
excretion of many used drugs is decreased in CKD which triggers these
drugs to cause much more QTcP (13,14).
In Jordan, around 3% of the population were estimated to have ESRD, and
the main causes were hypertension and diabetes mellitus (15–17).
Furthermore, high rate of drug-induced QTcP usage among geriatric
patients was reported, many of them had ESRD (18). However, a recent
study indicated that CKD is highly underdiagnosed in Jordan (19).
Physicians in Jordan demonstrated poor adherence to current practice
guidelines for safe prescription of antibiotics (20–23), proton pump
inhibitors (24,25), and non-steroidal anti-inflammatory drugs (26). In
addition, high rate of major and moderate drug-drug interactions was
found among elderly patients in Jordan (27). As a possible solution,
clinical pharmacists in Jordan exhibited the ability to identify and
intervene on such inappropriate prescriptions (28,29).
Given the high risk of mortality and morbidity due to inappropriate
prescribing of drug-induced QTcP for ESRD patients and scarcity of
available data on this area, we believe our multicentric approach to
assess prescribing behaviour of drug-induced QTcP is imperative to
provide a better understanding of the problem and urge health officials
for corrective actions. To our knowledge, there was no previous study
that targeted this patient group and assessed their prescriptions
meticulously.