Patients diagnosed with chronic kidney disease (CKD) who take a lot of prescription medications, have long hospital admissions, have hypertension or who are mature adults (but younger than 60) are at a higher risk of potential adverse drug interactions, researchers have found.
The study “Clinical relevancy and determinants of potential drug–drug interactions in chronic kidney disease patients: results from a retrospective analysis,” was published at Integrated Pharmacy Research and Practice.
Therapeutic regimens for CKD commonly require multiple and complex drug prescriptions, which in some situations can lead to unwanted side effects. These events can occur in the form of adverse drug reactions, hypersensitive reactions, or interactions between drugs. Either way, these adverse outcomes decrease the potential therapeutic effect of the prescribed drugs and may lead to the increased severity of CKD.
“To ensure rational prescribing in high-risk patients, it is necessary to evaluate and identify the factors causing DDIs [drug-drug interactions] before any adverse outcome occurs,” the authors wrote.
The study was carried out at the Bahawal Victoria Hospital in Pakistan, where researchers collected information from 209 patients with diagnosed chronic kidney disease admitted in the hospital’s nephrology unit from January 2013 to December 2014.
Most of the patients were men, and approximately 74% of the patients had stage 5 CKD. More than half of the patients were hospitalized longer than five days, and presented secondary illnesses such as diabetes and hypertension. About 78% of the patients were receiving treatment with more than five different drugs.
Researchers assessed potential drug-drug interactions (pDDIs) in CKD patients using the Micromedex Drug-Reax System software, which detects drug-specific interactions with high sensitivity and specificity.
The authors found 541 pDDIs in 164 (78.5%) of CKD patients. Regarding the severity of these pDDIs, they observed that 127 patients (60.8%) presented moderate interactions, 86 (41.1%) had minor, 58 (27.8%) had major, and 28 (13.4%) patients presented contraindicated interactions.
Some of the detected potential drug-drug interactions do not occur exclusively in CDK patients and have been reported in other clinical conditions, such as stroke, malaria, anemia, tuberculosis, and pneumonia.
A detailed analysis of the collected information showed that pDDIs were associated with adults younger than 60, longer periods of hospitalization (five or more days), the presence of secondary diseases such as hypertension, and an increased number of prescribed drugs (five or more). CKD patients who could be included in any of these groups had an increased risk of developing pDDIs.
“We suggest that the consequences of pDDIs should be considered carefully because some interactions that appear in the pDDI checking software do not occur in usual practice,” the authors wrote.
More studies are required to identify other factors that could impact the development of pDDIs, such as particular drug classes, disease diagnosis, and the type and number of secondary illnesses.