巴基斯坦一家三级护理医院的非透析慢性肾脏病患者的药物治疗问题的频率、类型和预测因素。
Frequency, types and predictors of drug therapy problems among non-dialysis chronic kidney disease patients at a tertiary care hospital in Pakistan.
机构信息
Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan.
Department of Nephrology, Bolan Medical College, Quetta, Pakistan.
出版信息
PLoS One. 2023 Apr 14;18(4):e0284439. doi: 10.1371/journal.pone.0284439. eCollection 2023.
BACKGROUND
Drug therapy problems (DTPs) are common among patients suffering from chronic kidney disease (CKD). However, there is a lack of information about DTPs and its predictors among CKD patients from Pakistan.
OBJECTIVES
To evaluate the frequency, type and predictors of various types of DTPs among CKD patients at a tertiary-care hospital in Pakistan.
METHODOLOGY
This was a cross-sectional study carried out at Sandeman Provincial Hospital, Quetta between 1-11-2020 and 31-1-2021. It included 303 non-dialysis ambulatory patients of CKD-stage 3 and above. Cipolle et al., criterion was used for classifying the DTPs and a clinician at the study site checked the identified DTPs for accuracy. Data were analyzed by SPSS 23. Multivariate analysis was conducted to find the predictors of individual types of DTPs. A p-value <0.05 was considered statistically significant.
RESULTS
The patients received a total of 2265 drugs with a median of eight drugs per patient (range: 3-15 drugs). A total of 576 DTPs were identified among 86.1% patients with a median of two DTPs (interquartile range 1-3) per patient. Dosage too high (53.5%) was the most common DTP followed by adverse drug reactions (ADRs) (50.5%) and need of additional drug therapy (37.6%). In multivariate analysis, patients' age of >40 years emerged as a predictor of unnecessary drug therapy and dosage too high. The odds of needing a different drug product was significantly high in patients with cardiovascular diseases (CVD) and diabetes mellitus (DM). The dosage too low had significant association with CVD. The risk of ADRs was significantly high in elderly patients (>60 years) and those with CVD. The presence of hypertension, DM and CKD stage-5 emerged as predictors of dosage too high.
CONCLUSION
This study revealed a high prevalence of DTPs among CKD patients. Targeted interventions in high risk patients may reduce the frequency of DTPs at the study site.
背景
药物治疗问题（DTP）在慢性肾脏病（CKD）患者中很常见。然而，关于巴基斯坦 CKD 患者的 DTP 及其预测因素的信息还很缺乏。
目的
评估巴基斯坦一家三级保健医院 CKD 患者中各种类型的 DTP 的频率、类型和预测因素。
方法
这是一项在 2020 年 11 月 1 日至 2021 年 1 月 31 日期间在 Quetta 的 Sandeman 省立医院进行的横断面研究。共纳入 303 名非透析门诊 CKD 3 期及以上患者。使用 Cipolle 等人的标准来对 DTP 进行分类，由研究地点的临床医生检查确定的 DTP 的准确性。使用 SPSS 23 进行数据分析。进行多变量分析以确定各类型 DTP 的预测因素。p 值<0.05 被认为具有统计学意义。
结果
患者共接受了 2265 种药物，每位患者的中位数为 8 种药物（范围：3-15 种）。86.1%的患者共发现 576 种 DTP，每位患者的中位数为 2 种 DTP（四分位距 1-3）。剂量过高（53.5%）是最常见的 DTP，其次是药物不良反应（50.5%）和需要额外药物治疗（37.6%）。多变量分析显示，患者年龄>40 岁是不必要药物治疗和剂量过高的预测因素。患有心血管疾病（CVD）和糖尿病（DM）的患者需要不同药物产品的可能性显著增加。剂量过低与 CVD 有显著关联。年龄较大（>60 岁）和患有 CVD 的患者发生药物不良反应的风险显著增加。高血压、DM 和 CKD 5 期的存在是剂量过高的预测因素。
结论
本研究显示 CKD 患者中 DTP 的患病率很高。在高危患者中进行针对性干预可能会降低研究地点 DTP 的频率。
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