Drug-related problems and associated factors in hospitalized patients with chronic kidney disease: A cross-sectional study

Aim: To determine the type, cause, severity and associated factors of DRPs in CKD patients, and then to assess the results of interventions by clinical pharmacists. Methods: A cross-sectional study was carried out to review all medication orders for hospitalized patients with CKD from April to September 2022. Pharmaceutical Care Network Europe classification (PCNE) V9.1 was used to classify the DRPs; Logistic regression models were used to estimate the factors of DRPs. Results: 176 patients with CKD stage 3-5 were included, and 249 DRPs were identified in 73.9% (130/176) of participants. The most common type of problem and cause respectively were “treatment effectiveness” (52.2%, 130/249) and “drug selection” (63.1%, 157/249). 84.7% (211/249) of the DRPs were rated at severity categories B to D (causing no or potential harm), whereas 15.3% (38/249) were rated as categories E to H (causing actual harm). Clinical pharmacists proposed 433 interventions, of which 89.4% (387/433) were entirely accepted and implemented, and solved 83.1% (207/249) DRPs. The probability of having at least one DRP was higher in patients treated with ten or more drugs (AOR 4.126, 95% CI 1.754-9.705, P=0.001), with CKD stages 5 (AOR 4.954, 95% CI 1.754-9.705, P=0.005), and with diabetes (AOR 4.224, 95% CI 1.889-9.445, P<0.001). Conclusions: DRPs are common in hospitalized CKD patients, and pharmacists play a significant role in optimizing medication therapy by identifying and resolving DRPs. The number of drugs, stage of CKD and diabetes are risk factors for DRPs, and we should pay attention to this specific group.