Assessment of drug utilization pattern and prescribing quality indicators among chronic kidney disease patients in a tertiary hospital in Northern Ghana

Abstract

Background: Drug utilization research in chronic kidney disease (CKD) patients can help identify drug utilization pattern, and evaluate quality of drug use by comparing to standard prescribing indicators or clinical guidelines. There is dearth of drug utilization study among CKD patients in Ghana, therefore this study aims to assess drug utilization pattern and quality prescribing indicators in CKD patients in Ghana. Methods: Retrospective study was conducted among CKD patients in the Tamale Teaching Hospital in northern region of Ghana. Results: Cardiovascular drugs were the commonly utilized across all stages of CKD (n=790,31.7%). Potential appropriate prescribing of antihypertensive agents (93.5%), and renin-angiotensin system (RAS) inhibitors alone (66.1%) were higher compared to combined RAS inhibitor with a diuretic (55.4%), phosphate binders (50.0%) and statins (35.6%). Patients with advance CKD stages received lower RAS inhibitors but higher statins compared to CKD stag-3 patients. There was optimal compliance with inappropriate prescription of dual RAS inhibitors, erythropoietin stimulating agent (ESA) and digoxin. Contraindication of metformin (57.9%) was higher than nonsteroidal anti-inflammatory drugs (NSAIDs) and NSAIDs + RAS inhibitor + diuretic; (1.2%) and (1.1%) respectively. Conclusions: This study is the first to assess prescribing quality indicators among CKD patients in Ghana and hence will serve as a baseline data for future drug utilization studies in the country. Priority areas for optimal prescribing include RAS inhibitors alone or combined with a diuretic, phosphate binders and statins when indicated. However, there is urgent need to mitigate contraindication prescription of metformin in the CKD patients.