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.