Drugs prescription pattern.

BackgroundDrug 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.ObjectivesTo evaluate the frequency, type and predictors of various types of DTPs among CKD patients at a tertiary-care hospital in Pakistan.MethodologyThis 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 ResultsThe 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.ConclusionThis 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（Drug Therapy Problems, DTPs）在慢性肾脏病（Chronic Kidney Disease, CKD）患者中十分常见，但目前巴基斯坦慢性肾脏病患者群体中关于DTPs及其预测因素的相关研究数据仍存在空白。
研究目的：评估巴基斯坦某三级医院慢性肾脏病患者各类DTPs的发生频率、类型及其预测因素。
研究方法：本研究为横断面研究，于2020年11月1日至2021年1月31日在巴基斯坦奎塔市桑德曼省立医院（Sandeman Provincial Hospital）开展。共纳入303例3期及以上慢性肾脏病非透析门诊患者。采用西波莱等（Cipolle et al.）制定的标准对DTPs进行分类，并由研究现场的临床医师对确认的DTPs进行准确性核验。采用SPSS 23统计软件进行数据分析，通过多因素分析明确各类DTPs的预测因素，本研究以P值＜0.05作为统计学显著性判定标准。
研究结果：所有患者共计使用2265种药物，人均用药中位数为8种（范围：3~15种）。共在86.1%的患者中检出576例DTPs，人均DTPs中位数为2例（四分位间距1~3）。剂量过高（53.5%）是最常见的DTP类型，其次为药品不良反应（Adverse Drug Reactions, ADRs）（50.5%）与额外药物治疗需求（37.6%）。多因素分析结果显示，年龄＞40岁的患者出现不必要药物治疗与剂量过高的风险更高。合并心血管疾病（Cardiovascular Diseases, CVD）与糖尿病（Diabetes Mellitus, DM）的患者，需要更换药物品种的比值比显著升高。剂量过低与心血管疾病存在显著关联。老年患者（＞60岁）及合并心血管疾病的患者发生ADRs的风险显著升高。高血压、糖尿病及5期慢性肾脏病为剂量过高的预测因素。
研究结论：本研究证实慢性肾脏病患者中DTPs的患病率较高，针对高风险患者开展靶向干预可降低本研究中心内DTPs的发生频率。