Tripathi Raakhi K, Pilliwar Chaitali, Gajbhiye Snehalata V, Bhilwade Sujeet K, Jamale Tukaram
Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
Department of Pharmacology, AIIMS, Nagpur, Maharashtra, India.
Perspect Clin Res. 2025 Jan-Mar;16(1):23-30. doi: 10.4103/picr.picr_308_23. Epub 2024 Aug 2.
Pharmacotherapy of chronic kidney disease (CKD) consists of prescribing myriad of drugs such as antihypertensives, antidiabetics, and phosphate binders to delay disease progression and control the comorbidities, resulting in inherent variability in prescriptions. In addition, tendency to self-medicate may further aggravate the condition. Hence, the present study was planned to assess self-medication practices and variability in prescription patterns in CKD patients.
A cross-sectional, questionnaire-based study approved by the ethics committee was conducted in CKD patients attending the nephrology outpatient department. The prescription details which included drug name, dosage form, dose, frequency, duration, and dosage instructions were recorded and prescription completeness was checked. To assess the tendency of CKD patients to self-medicate, each patient was administered a prevalidated [Content Validity Ratio (CVR) = 0.76] 8-item questionnaire which had dichotomous responses "Yes" and "No" and was scored as 2 and 0, respectively (total score 16).
Three hundred CKD patients (150 on hemodialysis and 150 nondialysis) yielded 300 prescriptions with 1272 drugs. It was evident that 33% of patients did self-medicate themselves with analgesics, and the mean score (7.81 ± 3.01) of self-medication practices was perceived significantly higher in the nondialysis group (8.41 ± 3.46). The most common classes of drugs prescribed in CKD patients were calcium channel blockers (41%), antidiabetic drugs (39%), diuretics (35%), gastrointestinal drugs (35%), and multivitamins (27%), with the average number of drugs being 5.84 ± 0.51.
Nearly one-third of CKD patients were self-medicating with paracetamol, nonsteroidal anti-inflammatory drugs; more in the nondialysis group emphasizing reinforcement of patient education programs. The most common drugs prescribed were amlodipine, followed by metformin, and the average number of drugs was less in our setting, indicating vigilant dose prescribing in CKD patients.
慢性肾脏病（CKD）的药物治疗包括开具多种药物，如抗高血压药、抗糖尿病药和磷结合剂，以延缓疾病进展并控制合并症，这导致处方存在内在变异性。此外，自我用药的倾向可能会进一步加重病情。因此，本研究旨在评估CKD患者的自我用药行为和处方模式的变异性。
在肾病门诊就诊的CKD患者中进行了一项经伦理委员会批准的横断面问卷调查研究。记录处方细节，包括药物名称、剂型、剂量、频率、疗程和用药说明，并检查处方完整性。为评估CKD患者自我用药的倾向，对每位患者进行了一份经过预验证的（内容效度比（CVR）=0.76）8项问卷，问卷有“是”和“否”两种二分回答，分别计分为2分和0分（总分16分）。
300例CKD患者（150例接受血液透析，150例未透析）产生了300份处方，共1272种药物。显然，33%的患者自行服用了镇痛药，未透析组自我用药行为的平均得分（7.81±3.01）明显高于透析组（8.41±3.46）。CKD患者最常开具的药物类别是钙通道阻滞剂（41%）、抗糖尿病药（39%）、利尿剂（35%）、胃肠道药物（35%）和多种维生素（27%），平均药物数量为5.84±0.51。
近三分之一的CKD患者自行服用对乙酰氨基酚及非甾体抗炎药；未透析组更多见，这强调了加强患者教育项目。最常开具的药物是氨氯地平，其次是二甲双胍，在我们的研究中平均药物数量较少，表明对CKD患者的剂量开具较为谨慎。
