European Journal of Biomedical and Pharmaceutical Sciences

RETROSPECTIVE EVALUATION OF DRUG THERAPY PROBLEMS IN CKD-ESRD PATIENTS AT CONNAUGHT TEACHING HOSPITAL COMPLEX – FREETOWN

*Dr Brian Thompson, Prof M. Samai, Prof Stella Usifoh

ABSTRACT

Background: Chronic kidney disease (CKD), especially end-stage renal disease (ESRD), is complexed with polypharmacy, causing drug therapy problems (DTPs), including adverse reactions, inappropriate doses, and interactions that add to morbidity and healthcare expenses. The purpose of this study was to determine, DTPs of hospitalized CKD patients using a standardized taxonomy. Methods: This retrospective study investigated drug therapy problems in hospitalized CKD-ESRD patients. A range of eligible records (n=98) available from the Records unit of Connaught Hospital Teaching Complex hospital were examined (January 2022-December 2024). Patients with documented drug therapy, aged 10 years and above were included. A structured questionnaire was used to identify and classify DTPs based on the patient needs domain of Indication, Effectiveness, Safety, and Adherence. The demographics, DTP prevalence and actions were summarized using descriptive statistics; inferential statistics were done using chi-square tests, correlation, ANOVA, t-tests and regressions (SPSS v.25, p<0.05). Results: The cohort (44.79+-16.23 years; 61.2% men) had an average length of stay of 13.00+-12.00 days and 2.18+-1.00 DTPs per patient (214 total). Safety (42.5%), Indication (36.4%), domains dominated; DTP of 81.8% were of high significance. The most prevalent specific types were unnecessary drug therapy and adverse drug reactions (23.4% each. These were caused by duplicate therapy (40% of unnecessary cases) and drug interactions (64% of adverse reactions), which highlight the polypharmacy risks in renal impairment. The most prevalent comorbidity was hypertension (54.1%). There were no sex differences in DTP categories (χ²=0.18, p=0.98) or in the prevalence of high-significance DTPs (χ²=0.12, p=0.73). There was a weak correlation between length of stay and DTP count (r=0.14, p=0.18); regressions did not demonstrate any significant predictor (R²=0.03, p=0.41). Only 50% of DTPs were noted to have interventions, most of which were discontinuations (25.2%). Conclusion: CKD pharmacotherapy is characterized by high-risk, high-frequency DTPs, with under-resolution of most of them, which demonstrates systemic gaps. Multidisciplinary reviews, renal dosing protocols and pharmacist incorporation are advised to augment outcomes and inform guidelines.

Keywords: Chronic Kidney Disease (CKD), End-Stage Renal Disease (ESRD), Drug Therapy Problems (DTPs), Polypharmacy.