The study of nephrotoxic medicines prescribed for in-patients with chronic kidney failure hospitalized in the First State Hospital

Abstract

Background: Drug pharmacokinetic and pharmacodynamic properties are changed due to decreasing of glomerular filtration rate, functional loss of tubular secretion and reabsorption in chronic renal failure. Risk factors for augmenting impairment of renal function are comorbodities and nephrotoxic drugs. The nephrotoxic drugs impair renal function and structures by severel mechanisms such as decreasing blood circulation, enhancing inflammation and producing free radicals. Therefore, it is crucial to pay close attention on drug prescription of patients with renal failure. Aim: We aimed to study nephrotoxic medicines prescribed for in-patients with chronic kidney failure hospitalized in the First State Hospital. Materials and Methods: Total of 306 patient’s medical charts were selected randomly who were hospitalized in nephrology department of First State Central Hospital between 2019-2021 with diagnosis of Chronic renal failure, confirmed by serum creatinine, aged ≥18 years. The study was conducted by cross sectional retrospective method. Results: In the regard of gender, 52.9% (n=162) of participants were male and 47.1% (n=144) of them were female. The mean number of drugs prescribed for these patients was 11.5±4.1 and the mean length of hospital stay was 8.2±3.4 days. There were prescribed nephrotoxic drugs for 98% (n=300) of total patients and the mean number of nephrotoxic drugs prescribed in each patient was 3.6±1.8. Nephrotoxic drugs were used in 98% (n=300) of all patients, and mean of 3.6±1.8 drugs were used concurrently per patient. Out of them, Clopidogrel 59.2% (n=181), Cefotaxime 47.7% (n=146), Amlodipine / Valsartan 46.1% (n=141), Pantoprazole 45.4% (n=139), and furosemide 22.9% (n=70) were the most commonly used drugs. Discussion: Patients who use angiotensin-converting enzyme inhibitors have a higher risk of developing renal failure when used in combination with diuretics than those who use low-dose or no diuretics. In addition, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients receiving renin angiotensin aldosterone blockers and diuretics increases the risk of renal failure. Conclusions: The number of contraindicated and nephrotoxic drugs prescriptions were higher in the end stage of renal failure. It shows that collaboration of physicians, pharmacologists and other medical professionals is essential for improving drug safety for patients with chronic renal failure.