DRUG-RELATED PROBLEMS IN CHRONIC KIDNEYS DISEASE PATIENTS IN AN INDONESIAN HOSPITAL: DO THE PROBLEMS REALLY MATTER?

Objective: To identify and evaluate drug-related problems (DRPs) in patients with chronic kidney disease (CKD). Methods: A prospective observational three-month study was conducted in adult patients with CKD hospitalized in five general medical wards and one intensive cardiac care unit in a major teaching hospital in Indonesia. Principal researcher (pharmacist) identified the occurrence of DRPs through the direct patient interview, discussion with nurses and assessment of patients’ medication charts and medical records. The identified DRPs were validated by a senior pharmacist and classified using Pharmaceutical Care Network Europe/PCNE classification scheme for DRP V6.2. Descriptive analysis was applied for demographic data, drug utilization and DRP profiles. Results: There were 105 patients who met the inclusion criteria and 80% of these patients had end-stage renal disease. A total of 2404 medication orders were reviewed and 1026 DRPs were identified. Potential DRPs accounted for around two-thirds of the cases. The rate of overall DRPs was 42.7 DRPs per 100 medication orders and each patient in the study experienced approximately ten DRPs during their hospitalization. Treatment effectiveness and adverse reaction domains contributed to the majority of DRPs primary domains for problems. Drugs for cardiovascular diseases and drugs for correcting electrolyte imbalance were most commonly implicated in DRP incidence. Conclusion: This study uncovered higher rate of DRPs experienced by each patient compared to other CKD studies. There were variations of DRP types when comparing with similar studies. Pharmacists’ competencies to identify, prevent and resolve DRPs are vital measures to improve clinical outcomes in CKD patients.