Assessment of rational utilization of drugs in adult patients with chronic renal failure at Kenyatta National Hospital.

Abstract

Background: Pharmacokinetics and pharmacodynamics of systemically administered drugs profoundly change when the renal function is compromised. This necessitates appropriate choice of drugs and dosing in such patients to avoid errors that can result to toxicity or under dosing. There is paucity of published data on the extent of rational use of drugs in compromised renal function in Kenyatta National Hospital. Objective: To assess the rational utilization of drugs in adult patients with chronic renal failure at Kenyatta National Hospital. Methodology Design: A cross section design Sample size: A sample of 72 adult patients with chronic renal failure was selected. The participants were either admitted in medical wards or those attending renal unit at Kenyatta National Hospital. Sampling technique: Simple random sampling was used where a coin was tossed. The patients who scored the tail were recruited as study participants. Data collection: Ethical approval was sought from Kenyatta National Hospital/University of Nairobi Ethical and Research committee and consent from both the patient and hospital management before collecting data. Data was collected using a predesigned structured questionnaire. The participants were interviewed to acquire socio-demographic characteristics and outcome of the treatment. Treatment modalities were obtained from the hospital records. Data Analysis: The data was analyzed using Statistical Package for Social Sciences version 20. Frequency tables and charts were used to summarize the data. Measures of central tendency and dispersion such as means, standard deviation, and interquartile ranges were used to analyze continuous data. Chi square was be used to find relationship between variables at 5% level of significance. xiv Results: The ratio between males and females was 5:3 and the mean age of the participants was 53.15 (±14.47). There was no isolated chronic kidney disease because all the participants had at least one comorbidity. Comorbidity was associated with polypharmacy (p<0.0001) where the mean number of drugs prescribed was 6.54 (±2.05) per patient. A total of 478 different types of drugs were prescribed for the participants of which 39.75% required dose adjustment. Almost a quarter of the drugs that required dose adjustment were done incorrectly and half (51.39%) of the participants had adverse drug reactions after treatment. Occurrence of adverse drug reactions was associated with the number of drugs the patient was taking (p=0.025) and inappropriate prescribing (p=0.001). Conclusion: There is polypharmacy in patients with chronic kidney disease because of associated comorbidities. Doses of a substantial number of drugs prescribed to patients with chronic kidney disease are not appropriately adjusted. This leads to poor treatment outcomes such as adverse drug reactions.