A Comprehensive Analysis of Predictors for Drug-Related Problems Among Ambulatory Patients with Chronic Kidney Disease in a Nephrology Outpatient Setting

Abstract

Drug-related problem refers to any situation or event associated with drug therapy that could potentially disrupt or interfere with a patient’s intended clinical outcome. While numerous predictors of drug-related problems have been identified, further investigation is needed in outpatient settings for patients with chronic kidney disease (CKD). Therefore, the objective of the study was to evaluate the comprehensive analysis of predictors for drug-related problems among ambulatory patients with chronic kidney disease in an outpatient nephrology setting. A single-arm, pre and post-intervention study design was used. In this study population consisted of adult patients diagnosed with CKD stages 1 to 5 and undergoing treatment and follow-up at Khyber Teaching Hospital (KTH) and Medical Teaching Institution (DHQ), Bannu, Khyber Pakhtunkhwa (KPK), Pakistan. Patients were recruited during the study period from February 2022 to June 2022, and then followed up from March 2022 to July 2022. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) software program version 26 for Windows (SP-SS, 2019). A 2-sided p-value < 0.05 was considered statistically significant. This study employed multivariable logistic regression models to identify predictors of drug-related problems (DRPs) among chronic kidney disease (CKD) patients. Initial analyses using Simple binary logistic regression explored associations between gender, age groups, body mass index (BMI), employment status, educational level, monthly income, number of medications, and CKD stages (eGFR ml/min) with DRPs. Variables with p-values <0.05 were further analysed through multiple binary logistic regression. Results revealed significant associations between various predictors and specific types of DRPs. The results of the multiple binary logistic regression indicate that patients with CKD stage 3, eGFR (G3a 45 - 59 ml/min), are 8.838 (95% CI: 2.211 - 35.326) times more likely to have a prescription of wrong drugs compared to the reference eGFR stage 1 (eGFR > 90 ml/min), with significant statistical association (P = 0.002), Likewise, patients who were prescribed 7 to 8 distinct medications showed a significant association (P = 0.002) with the occurrence of DRPs, these patients odd ratio with 14.272 times more likely to experience DRPs compared to those prescribed only 1 to 2 medications (95% CI: 2.650 - 76.871) when compared to individuals taking 1 to 2 medications. A statistically significant association (P = 0.014) was found among patients taking 7-8 medications, with an increased odds ratio (OR = 5.175) indicating a higher likelihood of poor adherence compared to those taking 1-2 medications. Unemployment within households was associated with a 5.303-fold increase in the likelihood of receiving wrong drug prescriptions (P=0.035, 95% CI: 1.128 - 24.929). The stage of chronic kidney disease (CKD) significantly influences the likelihood of incorrect prescriptions. Specifically, patients in stage 3 CKD (G3a, eGFR 45–59 ml/min) had an 8.838-fold higher risk (95% CI: 2.211 - 35.326) of receiving wrong prescriptions compared to those in stage 1 (eGFR > 90 ml/min, P=0.002). The likelihood of receiving duplicate prescriptions with similar effects was markedly higher in individuals with a monthly income of PKR 30-50K, with odds 6.004 times greater (95% CI: 1.548 - 23.297, P=0.010). Additionally, the probability was significantly elevated in cases with an increased number of medications, showing odds 14.272 times higher (P=0.002). Individuals diagnosed with stage 3 CKD have a significantly elevated likelihood (7.132 times greater) of being prescribed medications that are contraindicated for their condition. The confidence interval (95% CI: 2.075 - 24.514) indicates that this increased risk is statistically significant, with a p-value of 0.002 supporting that the observed effect is unlikely to be due to chance. Individuals earning between 30,000 and 50,000 PKR per month had a 3.096-fold increased likelihood of failing to adhere to their prescribed medication regimen compared to those in other income brackets. The confidence interval (95% CI: 1.140 - 8.412) indicates that this result is statistically significant, with a p-value of 0.027. The likelihood of receiving subtherapeutic dosages was found to be 30 times higher for individuals with a body mass index (BMI) between 18.5 and 24.5, with a 95% confidence interval ranging from 3.855 to 233.441 and a p-value of <0.1. This comprehensive analysis provides valuable insights into the factors influencing various types of DRPs among CKD patients, contributing to understanding medication management challenges and difficulties encountered in this particular population.

Funding: The authors declare that they have no financial support received for conducting this research

Declaration of Interest: The authors declare that they have no competing interests

Ethical Approval: This was a prospective study approved by ethical committee of Khyber Teaching Hospital.

Keywords: Chronic kidney disease, ambulatory patients, predictors, drug-related problems, outpatients, estimated glomerulus filtration