The drug utilization pattern and its related problem in patients new to long-term dialysis

• Main Authors: Jen-ChiehCheng, 鄭仁傑
• Other Authors: Ya-Hui Kao
• Format: Others
• Language: zh-TW
• Published: 2010
• Online Access: http://ndltd.ncl.edu.tw/handle/97938338885276641792

碩士 === 國立成功大學 === 臨床藥學研究所 === 98 === Background Pre-end stage renal disease (ESRD) patients and dialysis patients have multiple complications that require multiple medications to control the disease, which may further increase the risk of drug related problems. It has been proven in the literature that kidney disease in dialysis pateints、number of comorbidity、number of medication use and diabetes are risk factors for drug related problems. Nevertheless, among the various drug related problems in pre-ESRD and dialysis patients, the prescription patterns of inappropriate drugs (contraindication drugs) and the controversial medication (Non-Steroidal Anti-Inflammatory Drugs) have been rarely reported in the literature. Thus, the study objectives were to observe and analyze the prescription patterns including the inappropriate drugs such as hypoglycemic agents, hypolipidemic agents and NSAIDs, which might be used in dialysis patients. Methods We included new chronic dialysis patients who were identified from 1 Jan 2003 through 31 Dec 2003 and older than 18 years old by using National Health Insurance claims database. We obsevered one year period before and after the index date which was the date of the first dialysis recorded. The prescription patterns of inappropriate drugs and Non-Steroidal Anti-Inflammatory Drugs were analyzed according to demographic characteristics, number of drugs, comorbidities and health care settings. Results We identified 11,016 newly chronic dialysis patients after inclusion and exclusion criteria. There were 750 pateints (6.8 %) being prescribed inappropriate drug after dialysis and 2,453 patients (22.3 %) before dialysis. Comparing with the non-exposure group before dialysis, patients exposed to inappropriate drugs were older (61.4 years versus 58.6 years, p ＜0.0001), higher proportions in male (49.8% versus 46.7%, p = 0.0078) and more diabetics (91.0% versus 31.5%, p ＜0.0001), and received more medications within a month before starting dialysis (10.3 versus 9.3，p＜ 0.0001). In addition, comparing with the non-exposure group after dialysis, patients exposed to inappropriate drugs were older (61.5 years versus 59.0 years, p ＜0.0001), higher proportions in male (52.0% versus 47.2%, p = 0.0097) and more diabetics (79.3% versus 42.2%, p ＜0.0001), and received more medications within a month after dialysis (11.9 versus 9.7，p ＜ 0.0001). There were 7,039 patients (63.9 %) being prescribed NSAIDs before dialysis, and 6,683 patients (60.6 %) after dialysis. Patents were classified into three groups according to one year cumulative dose of NSAIDs. Before dialysis, the patients in the group with high dose (＞ 90th DDD) were older than the non-exposure group and the low does group (64.8 years versus 57.9 years versus 59.5 years, p ＜0.0001), and have higher proportion of gout (41.1 % versus 8.8 % versus 18.0 %，p ＜ 0.0001); Gender and diabetics have no differences in these three groups. After dialysis, the patients in the group with high dose (＞ 90th DDD) were older than the non-exposure group and the low dose group (64.5 years versus 58.0 years versus 59.5 years, p ＜0.0001), and have higher proportions in females (54.7 % versus 50.4 % versus 53.8 %，p=0.0015), additionally, the proportion of gout is the highest in the high dose group (29.1 % versus 11.7 % versus 17.5 %，p ＜ 0.0001); Diabetic proportion is the highest in the low dose group (p=0.0324). Conclusion Long-term dialysis population may have multiple drugs, being prescribed inappropriate drugs as well as non-steroidal anti-inflammatory drugs and other drug-related problems. Patients who were older, male, diabetes, received more medicaitions, and prescription from regional hospitals and medical centers, prescribed higher proportion of inappropriate medications. Patients who were older, female, gout patients, and prescription from primary care clinics and district hospitals, prescribed higher proportion of non-steroidal anti-inflammatory drugs.