Fasipe Olumuyiwa John, Akhideno Peter Ehizokhale, Nwaiwu Obiyo, Adelosoye Alex Adedotun
Department of Pharmacology & Therapeutics, University of Medical Sciences, Ondo City, Ondo State.
Department of Internal Medicine, Irrua Specialist Teaching Hospital, Irruar, Edo State.
Clin Pharmacol. 2017 Oct 26;9:125-132. doi: 10.2147/CPAA.S147835. eCollection 2017.
Life expectancy has increased significantly among chronic kidney disease (CKD) patients due to the extensive use of polypharmacy practice for medication prescriptions. This predisposes them to potential drug-drug interactions (DDIs), which can lead to an increase in morbidity, mortality, length of hospital stay, and health care cost.
This was a 30-month retrospective study that reviewed the medical case records of consenting adult CKD patients from January 2014 to June 2016. The Medscape drug reference database was used to evaluate patients' medications for potential DDIs.
This study involved 123 adult CKD patients (63 [51.22%] males and 60 [48.78%] females) with a mean age of 53.81±16.03 years. The most common comorbid conditions were hypertension (112 [91.10%]) and diabetes mellitus (45 [36.60%]). Regarding the form of nephrological interventions being offered, the majority of the respondents - 66 (53.66%) were on maintenance dialysis, followed by 53 (43.09%) respondents on conservative care, while 4 (3.25%) respondents were on renal transplantation. A total of 1264 prescriptions were made, and the mean number of prescribed medications per patient was 10.28±3.85. The most frequently prescribed medications were furosemide (88 [71.6%]), heparin (67 [54.47%]), lisinopril (65 [52.9%]), oral calcium carbonate (CaCO) (63 [51.2%]), α-calcidol (62 [50.4%]), and erythropoietin (61 [49.6%]). A total number of 1851 potential DDIs were observed among 118 patients. The prevalence of potential DDIs in this study was 78.0%, while the mean DDI per prescription was 1.50. Among the potential DDIs observed, the severity was mild in 639 (34.5%) patients, moderate in 1160 (62.7%) patients, and major in 51 (2.8%) patients and only 1 (0.1%) patient was of contraindicated drug combination. The most frequent DDIs' pattern observed was between oral CaCO and oral ferrous sulfate. There was a statistically significant association between the number of prescribed medications and the estimated glomerular filtration rate (eGFR; pre-ESRD and ESRD staging) with a -value of 0.00000119. This implies that the number of prescribed medications increases as the eGFR declines in advance CKD stage patients.
Most of these interactions have moderate severity and delayed onset, hence the need to follow-up these patients after prescription in order to reduce associated morbidity, mortality, length of hospital stay, and health care cost. Physicians and clinical pharmacists should utilise available interaction software to avoid harmful DDIs in these patients.
由于在药物处方中广泛采用多种药物联合治疗，慢性肾脏病（CKD）患者的预期寿命显著增加。这使他们易于发生潜在的药物相互作用（DDIs），进而可能导致发病率、死亡率、住院时间和医疗费用增加。
这是一项为期30个月的回顾性研究，回顾了2014年1月至2016年6月间同意参与研究的成年CKD患者的医疗病例记录。使用Medscape药物参考数据库评估患者的药物是否存在潜在的药物相互作用。
本研究纳入了123例成年CKD患者（男性63例[51.22%]，女性60例[48.78%]），平均年龄为53.81±16.03岁。最常见的合并症是高血压（112例[91.10%]）和糖尿病（45例[36.60%]）。关于所提供的肾脏科干预形式，大多数受访者——66例（53.66%）接受维持性透析，其次是53例（43.09%）接受保守治疗的受访者，而4例（3.25%）受访者接受肾移植。共开出1264份处方，每位患者的平均处方药物数量为10.28±3.85。最常开具的药物是呋塞米（88例[71.6%]）、肝素（67例[54.47%]）、赖诺普利（65例[52.9%]）、口服碳酸钙（CaCO）（63例[51.2%]）、α-骨化醇（62例[50.4%]）和促红细胞生成素（61例[49.6%]）。在118例患者中总共观察到1851种潜在的药物相互作用。本研究中潜在药物相互作用的发生率为78.0%，每份处方的平均药物相互作用数为1.50。在观察到的潜在药物相互作用中，639例（34.5%）患者的严重程度为轻度，1160例（62.7%）患者为中度，51例（2.8%）患者为重度，只有1例（0.1%）患者为禁忌药物组合。观察到的最常见药物相互作用模式是口服CaCO与口服硫酸亚铁之间的相互作用。处方药物数量与估计肾小球滤过率（eGFR；终末期肾病前期和终末期肾病分期）之间存在统计学显著关联，P值为0.00000119。这意味着在CKD前期患者中，随着eGFR下降，处方药物数量增加。
这些相互作用大多具有中度严重程度且起病延迟，因此需要在处方后对这些患者进行随访，以降低相关的发病率、死亡率、住院时间和医疗费用。医生和临床药师应利用现有的相互作用软件，避免这些患者发生有害的药物相互作用。
