Determinants and outcomes of hyperpolypharmacy among chronic kidney disease patients in a teaching hospital in Northern Ghana

Abstract

Background: There is paucity of drug utilization studies among patients with chronic kidney disease (CKD) patients in Ghana. This study aimed to evaluate drug utilization pattern focusing on prevalence of hyperpolypharmacy and its determinants and outcomes among CKD patients in a teaching hospital in northern Ghana. Methods: A retrospective cross-sectional was conducted among patients with CKD patients in the Tamale Teaching Hospital (TTH). Results: Drugs acting on the cardiovascular system were the most commonly utilized (n=639/2081, 30.7%). Majority of the CKD patients 107/198 (54.0%) utilized prescriptions with ≥10 drugs concurrently (i.e. hyperpolypharmacy). Patients with 3-4 and ≥5 comorbidities were 5.3 times (AOR=5.3, 95% CI: 1.39-20.30, p=0.015) and about 8-folds (AOR=7.9, 95% CI: 2.04-30.31, p=0.003) more likely to have hyperpolypharmacy respectively. Exposure to hyperpolypharmacy was significantly associated with potential drug-drug interactions; contraindicated (OR=6.3, 95% CI: 2.51-15.92, p<0.001), serious-use alternative (OR=3.2, 95% CI: 1.71-5.73, p<0.001), and monitor closely (OR=3.1, 95% CI: 1.75-5.98, p<0.001), exposure to hyperpolypharmacy resulted in 4-folds higher likelihood to stay >7 days hospitalization (AOR=4.1, 95% CI: 2.26-7.51, p<0.001). Conclusions: The presence of three or more comorbidities was an independent determinant of hyperpolypharmacy. which was associated with adverse outcomes; increased severity of potential drug-drug interactions and longer hospitalization. Hence, clinicians of TTH need to implement measures to prevent hyperpolypharmacy among CKD patients to help mitigate its associated burden.