TO ASSESS THE APPROPRIATE DOSING OF ANTIMICROBIALS, ANTIHYPERTENSIVES AND ORAL HYPOGLYCEMIC AGENTS IN CHRONIC KIDNEY DISEASE PATIENTS AT TERTIARY CARE HOSPITAL: A RETROSPECTIVE, OBSERVATIONAL STUDY

Background: In patient with renal dysfunction, the renal excretion of the parent drug and its metabolite is already impaired leading to accumulation and toxicity. Also the activities of drug metabolizing enzymes and drug transporter are reduced. In such patients, medication dosing errors become the important Drug Related Problem which needs to be assessed closely. Objectives: This study aims at assessment of appropriate dosing of Antimicrobials (AMA), Anti hypertensives (AHA) and Oral Hypoglycemic Agents (OHA) in patients with Chronic Kidney Disease at the tertiary care hospital in India. Materials and Methods: A Retrospective, Observational study was conducted for 110 patients at a tertiary care hospital in Surat between Jan, 2020 to Jan, 2021. It included patients diagnosed with CKD stage 3, 4 and 5 who were prescribed with at least one antimicrobial, antihypertensive or oral hypoglycemic agent. Kidney function was estimated from GFR using MDRD equation, and dose appropriateness was determined by comparing practice with relevant reference books. Results: For the total 110 CKD patients - 361 drugs were prescribed which included 199 (55.12%) AHA, 53 (14.68%) OHA and 109 (30.19%) AMA. 328 drugs out of 361 were prescribed correctly with dose adjustment as required for all of three classes of drugs with majorly being AMA18 (16.5%), by OHA 04 (7.55%) followed by AHA 03 (1.5%). Overall adjustment was required in 25 prescribed drugs. Apart from these, there were a total 8 contraindicated drugs which were all oral hypoglycemic. Conclusion: Our study concludes that, according to individual patient’s GFR most of the AHA prescribed were adjusted appropriately whereas some of the AMA required adjustment and few OHA prescribed were contraindicated.