Drug-related problems and associated factors in hospitalized patients
with chronic kidney disease: A cross-sectional study
Abstract
Aim: To determine the type, cause, severity and associated factors of
DRPs in CKD patients, and then to assess the results of interventions by
clinical pharmacists. Methods: A cross-sectional study was carried out
to review all medication orders for hospitalized patients with CKD from
April to September 2022. Pharmaceutical Care Network Europe
classification (PCNE) V9.1 was used to classify the DRPs; Logistic
regression models were used to estimate the factors of DRPs. Results:
176 patients with CKD stage 3-5 were included, and 249 DRPs were
identified in 73.9% (130/176) of participants. The most common type of
problem and cause respectively were “treatment effectiveness” (52.2%,
130/249) and “drug selection” (63.1%, 157/249). 84.7% (211/249) of
the DRPs were rated at severity categories B to D (causing no or
potential harm), whereas 15.3% (38/249) were rated as categories E to H
(causing actual harm). Clinical pharmacists proposed 433 interventions,
of which 89.4% (387/433) were entirely accepted and implemented, and
solved 83.1% (207/249) DRPs. The probability of having at least one DRP
was higher in patients treated with ten or more drugs (AOR 4.126, 95%
CI 1.754-9.705, P=0.001), with CKD stages 5 (AOR 4.954, 95% CI
1.754-9.705, P=0.005), and with diabetes (AOR 4.224, 95% CI
1.889-9.445, P<0.001). Conclusions: DRPs are common in
hospitalized CKD patients, and pharmacists play a significant role in
optimizing medication therapy by identifying and resolving DRPs. The
number of drugs, stage of CKD and diabetes are risk factors for DRPs,
and we should pay attention to this specific group.