Medication Prescribing Patterns for Chronic Kidney Diseases: Analysis of Drug-Dose Adjustments, Polypharmacy, and Drug Interactions

Abstract

Background: Multiple drug prescriptions in chronic kidney disease (CKD) escalate metabolic buildup, nephrotoxicity, and end stage kidney disease progression. We aimed to study polypharmacy and harmful multi-drug interactions at the nephrology department of South-Kazakhstan Regional hospital. Methods: We analyzed electronic medical records of 485 patients with glomerular diseases (ICD-10 codes: N00-N08) admitted to the nephrology department from January 2018 to December 2021. We evaluated polypharmacy risk, dividing patients into low-risk, moderate-risk, and severe-risk groups based on the number of prescribed medications: 2-5, 6-9, and 10 or more, respectively. Additionally, we examined the occurrence and combinations of unsafe multi-drug interactions. Results: The study group included 45% CKD stage-1, 29% CKD stage-2, and 26% CKD stage-3 and above patients, with a median medication count of 9.5. Low-risk, moderate-risk, and severe-risk polypharmacy affected 12.2%, 48.2%, and 39.6% of patients, respectively. Inappropriate multi-drug combinations were particularly prevalent in early CKD stages. Notably, among commonly prescribed drugs, 19 out of 23 lacked dose adjustments according to the CKD stage. Conclusion: This pioneering study investigates polypharmacy and multi-drug interactions in CKD patients in Kazakhstan, revealing significant risks.