Patterns of drug use and polypharmacy burden in chronic kidney disease patients: An experience from a secondary care hospital in United Arab Emirates

2021 ◽  
Author(s):  
Tasneem M. Shouqair ◽  
Syed Arman Rabbani ◽  
Martin Thomas Kurian
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Drug Use ◽  
United Arab Emirates ◽  
Secondary Care ◽  
Care Hospital

scholarly journals Assessment of implementation of antibiotic stewardship program in surgical prophylaxis at a secondary care hospital in Ras Al Khaimah, United Arab Emirates

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hessa Saleh Alshehhi ◽  
Areeg Anwer Ali ◽  
Duaa Salem Jawhar ◽  
Essam Mahran Aly ◽  
Srinivas Swamy ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
United Arab Emirates ◽  
Antibiotic Stewardship ◽  
Secondary Care ◽  
Care Hospital ◽  
Surgical Prophylaxis ◽  
Patient Profile ◽  
Stewardship Program ◽  
Prescribing Practice ◽  
Surgical Antibiotic Prophylaxis

AbstractAntibiotic overuse is a major factor for causing antibiotic resistance globally. However, only few studies reported the implementation and evaluation of antimicrobial stewardship programs in Gulf Cooperation Council. This study was conducted within 8-months periods to evaluate the effect of the newly implemented antibiotic stewardship program on improving the prescribing practice of surgical antibiotic prophylaxis in a secondary care hospital in the United Arab Emirates by releasing local hospital guidelines. The data of 493 in patients were documented in the predesigned patient profile form and the prescribing practice of surgical antibiotic prophylaxis for clean and clean-contaminant surgical procedures was compared and analyzed two months’ prior (period A) and post (period B) the implementation of antibiotic stewardship program. The 347 patient’s data (PD) were analyzed during period A and 146 PD during period B. The prescription of piperacillin/tazobactam was decreased from 2.4% from all surgical prophylaxis antibiotic orders in period A to 0% in period B. The appropriateness of the antibiotic therapy was found to differ non significantly for the selection of prophylactic antibiotic (p = 0.552) and for the timing of first dose administration (p = 0.061) between A and B periods. The total compliance was decreased non significantly (P = 0.08) from 45.3 to 40.2%. Overall, the guidelines have improved the prescribing practice of antibiotics prior to surgery. However, further improvement can be achieved by initiating educational intervention via cyclic auditing strategy.

Proton pump inhibitor use and appropriateness analysis: a snapshot from a secondary care hospital

2021 ◽  
Author(s):  
Sukaina Salim Damji ◽  
Syed Arman Rabbani ◽  
Padma G M Rao ◽  
Ain-ur Rashid Butt
Keyword(s):  
United Arab Emirates ◽  
Proton Pump ◽  
Secondary Care ◽  
Stress Ulcer ◽  
Risk Category ◽  
Care Hospital ◽  
High Prevalence ◽  
Potential Risks ◽  
Internal Medicine Wards ◽  
Ulcer Prophylaxis

Abstract Objectives Proton pump inhibitors (PPIs) have become one of the most frequently prescribed drugs since their introduction 30 years ago. Effectiveness and safety profile of PPIs has led to their overutilization and has exposed patients to a number of potential risks. The objective of this study was to evaluate the use of PPIs in a secondary care hospital in the United Arab Emirates. Methods This prospective observational drug-utilization study was conducted in patients receiving treatment with PPIs and admitted to internal medicine wards of the study site. Electronic patient case records were reviewed and data on PPI prescribing was collected and analysed. Appropriateness of PPI use was assessed as per international guidelines. Key findings Out of 172 patients enrolled, 53.5% were females with median age of 57 years (34.3, 71.0). Four different PPIs were prescribed to study patients, pantoprazole (86.6%), esomeprazole (5.8%), rabeprazole (4.1%) and omeprazole (3.5%). Ninety-two (53.5%) patients were prescribed intravenous PPI, whereas 80 (46.5%) patients were given PPI in oral form. Overall, 103 (59.9%) patients had inappropriate PPI prescriptions. Of these inappropriate prescriptions, 22 patients had no clear indication for PPI use and for 16 patients; PPIs were indicated for stress ulcer prophylaxis in low-risk category. Corticosteroid use [odds ratio (OR): 4.34, 95% confidence interval (CI): 1.22–15.46; P = 0.023] was significantly associated with greater odds of inappropriate PPI use. Conclusions We report a high prevalence of inappropriate PPI prescribing among the hospitalized patients in our study. Inappropriate PPI prescribing is a concerning issue and collective efforts should be made to check and minimize the same.

To Study Thyroid Function and Lipid Profile Levels in Chronic Kidney Disease Patients in a Tertiary Care Hospital of North India

2021 ◽  
Vol 8 (32) ◽  
pp. 2980-2987
Author(s):  
Navjot Kaur Layal ◽  
Tejinder Sikri ◽  
Jaskiran Kaur ◽  
Jasmine Kaur ◽  
Hardeep Singh Deep
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Lipid Profile ◽  
Thyroid Dysfunction ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Low Density ◽  
Care Hospital ◽  
Low T3 ◽  
Group A

BACKGROUND Chronic kidney disease (CKD) includes a spectrum of different pathophysiology processes associated with abnormal kidney function, and a progressive decline in GFR. Progression of CKD is associated with having a number of complications, including thyroid dysfunction, dyslipidaemia, and cardiovascular diseases. METHODS The present study was conducted among 60 CKD patients (cases) and 60 healthy controls to compare their thyroid and lipid profile, who attended the Department of Medicine in SGRDIMSR, Sri Amritsar from January 2019 to December 2020.These 60 CKD patients were grouped as group A. Group A was further divided into various stages as per KIDGO staging according to GFR. 60 healthy individuals were taken as controls and were kept as Group B. Demographic features (age and sex) and medical history of diabetes mellitus, hypertension were noted and blood samples (5mL) were analysed for blood urea, serum creatinine, free triiodothyronine (T3), free thyroxine (T4), thyroid stimulating hormone (TSH), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), very low density lipoprotein (VLDL) and triglycerides. RESULTS Thyroid dysfunction was observed in patients of CKD, the most common being overt hypothyroidism (56.6 %) followed by subclinical hypothyroidism (16.6 %), low T3 (15 %), and hyperthyroidism (1.6 %). Hypercholesterolemia, low HDL, elevated LDL, VLDL and triglyceride levels were observed in 74.9 %, 85.0 %, 38.3 %, 41.6 % and 76.6 % patients, respectively. Patients with CKD with 5 had significantly higher risk of having thyroid dysfunction and dyslipidaemia as compared to patients with stage 3 and 4. CONCLUSIONS Thyroid dysfunction and dyslipidaemia were common in patients with CKD. Prevalence of hypothyroidism, dyslipidaemia increases with progression of CKD. Hence early detection of thyroid dysfunction and dyslipidaemia is imperative to improve mortality and morbidity of CKD patients. KEYWORDS Chronic Kidney Disease, Dyslipidaemia, Thyroid Dysfunction

Correlation of Iron Profile with Different Stages of Chronic Kidney Disease in Children Presenting at a Tertiary Care Hospital

2021 ◽  
Vol 15 (8) ◽  
pp. 2013-2016
Author(s):  
Shahid Ishaq ◽  
Muhammad Imran ◽  
Hashim Raza ◽  
Khuram Rashid ◽  
Muhammad Imran Ashraf ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Iron Overload ◽  
Serum Ferritin ◽  
Serum Iron ◽  
Tertiary Care ◽  
Transferrin Saturation ◽  
Maintenance Hemodialysis ◽  
Care Hospital ◽  
Iron Profile

Aim: To determine correlation of iron profile in children with different stages of chronic kidney disease (CKD) presenting to tertiary care hospital. Methodology: A total of 81 children with chronic kidney disease stage having glomerular filtration rate (GFR) less than 90 (ml/min/m2) aged 1 – 14 years of either sex were included. Three ml serum sample was taken in vial by hospital duty doctor for serum ferritin level, serum iron, transferrin saturation and total iron binding capacity. The sample was sent to hospital laboratory for reporting. Iron profiling was done evaluating hemoglobin (g/dl), serum iron (ug/dl), serum ferritin (ng/ml), transferrin saturation (%) and total iron binding capacity (ug/dl) while iron load was defined as serum ferritin levels above 300 ng/ml. Correlation of iron profile with different stages of CKD was determined applying one-way analysis of variance (ANOVA). Results: In a total 81 children, 46 (56.8%) were boys while overall mean age was 7.79±2.30 years. Mean duration on hemodialysis was 11.52 ± 9.97 months. Iron overload was observed in 26 (32.1%) children. Significant association of age above 7 years (p=0.031) and residential status as rural (p=0.017) was noted with iron overload whereas iron overload was increasing with increase in stages of CKD (p=0.002). Hemoglobin levels decreased significantly with increase in stages of CKD (p<0.001). Serum iron levels increased significantly with increase in the CKD stages (p=0.039). Serum ferritin levels were increasing significantly with the increase in CKD stages (p=0.031). Transferrin saturation also increased significant with increase in CKD stages (p=0.027). Conclusion: High frequency of iron overload was noted in children with CKD on maintenance hemodialysis and there was linear relationship with stages of CKD and iron overload. Significant correlation of hemoglobin, serum iron, serum ferritin and transferrin saturation was observed with different stages of CKD. Keywords: Iron overload, maintenance hemodialysis, ferritin level.

scholarly journals A study of secondary hyperparathyroidism in patients with chronic kidney disease in a tertiary care hospital

2019 ◽  
Vol 6 (2) ◽  
pp. 271
Author(s):  
Vishnu Shankar H. ◽  
Mahendra Kumar K. ◽  
Jagadeesan M. ◽  
Kannan R. ◽  
Chitrambalam P. ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Cross Sectional ◽  
Study Population ◽  
Chronic Morbidity ◽  
Spss Software

Background: Secondary hyperparathyroidism (SHPT) is one of the less recognized complications in patients with chronic kidney disease (CKD). The prevalence of SHPT in various stages of CKD was evaluated by measuring the levels of intact parathyroid hormone (iPTH).Methods: This cross-sectional study was carried out in 100 CKD patients. Serum creatinine, calcium, phosphorous and iPTH levels were measured and statistical analysis was carried out using the SPSS software (IBM, NY, USA).Results: Among the 100 participants, the mean age (SD) was 59.3 (7.8) years. In our study population, 52% were men and the rest were females. Hypertension (75%) was the most common chronic morbidity. Prevalence of hyperparathyroidism among chronic kidney disease patients was 22% (95% CI: 14.7-30.9%). The prevalence of secondary hyperparathyroidism among dialysis and non-dialysis patients were 30% and 14% respectively which was statistically significant.Conclusions: SHPT is an important complication which is often underdiagnosed. Secondary hyperparathyroidism starts to develop when eGFR falls below 60ml/min. PTH levels starts to rise as the disease progress. Hence it is important for the treating physicians to monitor the PTH levels early in the course of CKD to prevent and treat bone mineral disease.

scholarly journals HEMATOLOGICAL PROFILE IN PATIENTS OF CHRONIC KIDNEY DISEASE WITH ITS SEVERITY IN A TERTIARY CARE HOSPITAL, NORTH ODISHA

2020 ◽  
pp. 182-187
Author(s):  
BIBHU PRASAD BEHERA
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Hematological Parameters ◽  
Tertiary Care ◽  
Microcytic Anemia ◽  
Treatment Modalities ◽  
Unknown Etiology ◽  
Care Hospital ◽  
College Hospital ◽  
Correct Treatment

Objective: Efforts can be made to normalize the hematological parameters and slow the progress of the disease so that the morbidity and mortality in these patients with chronic kidney disease could be effectively reduced. Methods: The observational study was carried out in the Department of General Medicine, Pandit Raghunath Murmu Medical College Hospital, Baripada, between May 2018 and January 2019. Two hundred seventy patients of chronic kidney disease (CKD) above 15 years of age, satisfying the inclusion and exclusion criteria, were included in the study. Results: In our study, 179 (66.30%) were male, and 91 (33.70%) were female with M:F of 1.97:1. The average age of the patients in the study was 55.72±12.77 years. About 42.59 % (115) of the patients were between 46 and 60 years of age. About 35.56% of CKD cases had determined etiology and, 64.44% of cases had unknown etiology. Hemoglobin, RBC, and packed cell volume were significantly lower in the patients with CKD compared to the controls (p=0.0001), and RDW was considerably higher in the patients with CKD compared to the controls (p=0.0001). Microcytic anemia was the most prevalent type of anemia. There was a hugely significant association between the prevalence of thrombocytopenia and the severity of CKD (p=0.006). Conclusion: This study concluded that patients with CKD show abnormal hematological parameters. Evaluation of hematological parameters in these patients helps in classifying the type of anemia, aids in choosing the correct treatment modalities, and decreases mortality.

scholarly journals Prescribing quality in secondary care patients with different stages of chronic kidney disease: a retrospective study in the Netherlands

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e025784 ◽  
Author(s):  
Kirsten PJ Smits ◽  
Grigory Sidorenkov ◽  
Frans J van Ittersum ◽  
Femke Waanders ◽  
Henk JG Bilo ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Secondary Care ◽  
Phosphate Binders ◽  
Active Vitamin ◽  
Active Vitamin D ◽  
Prescribing Quality ◽  
Raas Inhibitors ◽  
To Receive

ObjectivesInsight in the prescribing quality for patients with chronic kidney disease (CKD) in secondary care is limited. The aim of this study is to assess the prescribing quality in secondary care patients with CKD stages 3–5 and possible differences in quality between CKD stages.DesignThis was a retrospective cohort study.SettingData were collected at two university (n=569 and n=845) and one non-university nephrology outpatient clinic (n=1718) in the Netherlands.ParticipantsBetween March 2015 and August 2016, data were collected from patients with stages 3a–5 CKD seen at the clinics. Blood pressure measurements, laboratory measurements and prescription data were extracted from medical records. For each prescribing quality indicator, patients with incomplete data required for calculation were excluded.Outcome measuresPotentially appropriate prescribing of antihypertensives, renin-angiotensin-aldosterone system (RAAS) inhibitors, statins, phosphate binders and potentially inappropriate prescribing according to prevailing guidelines was assessed using prescribing quality indicators. Χ2or Fisher’s exact tests were used to test for differences in prescribing quality.ResultsRAAS inhibitors alone or in combination with diuretics (57% or 52%, respectively) and statins (42%) were prescribed less often than phosphate binders (72%) or antihypertensives (94%) when indicated. Active vitamin D was relatively often prescribed when potentially not indicated (19%). Patients with high CKD stages were less likely to receive RAAS inhibitors but more likely to receive statins when indicated than stage 3 CKD patients. They also received more active vitamin D and erythropoietin-stimulating agents when potentially not indicated.ConclusionsPriority areas for improvement of prescribing in CKD outpatients include potential underprescribing of RAAS inhibitors and statins, and potential overprescribing of active vitamin D. CKD stage should be taken into account when assessing prescribing quality.

scholarly journals Agreement Between Administrative Database and Medical Chart Review for the Prediction of Chronic Kidney Disease G category

2020 ◽  
Vol 7 ◽  
pp. 205435812095990
Author(s):  
Louise Roy ◽  
Michael Zappitelli ◽  
Brian White-Guay ◽  
Jean-Philippe Lafrance ◽  
Marc Dorais ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Drug Use ◽  
Filtration Rate ◽  
Drug Benefit ◽  
Administrative Databases ◽  
Specific Drug ◽  
Cohort Entry

Background: Chronic kidney disease (CKD) is a major health issue and cardiovascular risk factor. Validity assessment of administrative data for the detection of CKD in research for drug benefit and risk using real-world data is important. Existing algorithms have limitations and we need to develop new algorithms using administrative data, giving the importance of drug benefit/risk ratio in real world. Objective: The aim of this study was to validate a predictive algorithm for CKD GFR category 4-5 (eGFR < 30 mL/min/1.73 m2 but not receiving dialysis or CKD G4-5ND) using the administrative databases of the province of Quebec relative to estimated glomerular filtration rate (eGFR) as a reference standard. Design: This is a retrospective cohort study using chart collection and administrative databases. Setting: The study was conducted in a community outpatient medical clinic and pre-dialysis outpatient clinic in downtown Montreal and rural area. Patients: Patient medical files with at least 2 serum creatinine measures (up to 1 year apart) between September 1, 2013, and June 30, 2015, were reviewed consecutively (going back in time from the day we started the study). We excluded patients with end-stage renal disease on dialysis. The study was started in September 2013. Measurement: Glomerular filtration rate was estimated using the CKD Epidemiological Collaboration (CKD-EPI) from each patient’s file. Several algorithms were developed using 3 administrative databases with different combinations of physician claims (diagnostics and number of visits) and hospital discharge data in the 5 years prior to the cohort entry, as well as specific drug use and medical intervention in preparation for dialysis in the 2 years prior to the cohort entry. Methods: Chart data were used to assess eGFR. The validity of various algorithms for detection of CKD groups was assessed with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: A total of 434 medical files were reviewed; mean age of patients was 74.2 ± 10.6 years, and 83% were older than 65 years. Sensitivity of algorithm #3 (diagnosis within 2-5 years and/or specific drug use within 2 years and nephrologist visit ≥4 within 2-5 years) in identification of CKD G4-5ND ranged from 82.5% to 89.0%, specificity from 97.1% to 98.9% with PPV and NPV ranging from 94.5% to 97.7% and 91.1% to 94.2%, respectively. The subsequent subgroup analysis (diabetes, hypertension, and <65 and ≥65 years) and also the comparisons of predicted prevalence in a cohort of older adults relative to published data emphasized the accuracy of our algorithm for patients with severe CKD (CKD G4-5ND). Limitations: Our cohort comprised mostly older adults, and results may not be generalizable to all adults. Participants with CKD without 2 serum creatinine measurements up to 1 year apart were excluded. Conclusions: The case definition of severe CKD G4-5ND derived from an algorithm using diagnosis code, drug use, and nephrologist visits from administrative databases is a valid algorithm compared with medical chart reviews in older adults.

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