Assessment of Potentially Nephrotoxic Drug Prescriptions in Chronic Kidney Disease Outpatients at a Hospital in Indonesia.

Abstract

Background: Nephrotoxic drugs can worsen the kidney function of patients with chronic kidney disease (CKD). There is still a limited amount of research investigating nephrotoxic drugs in Indonesia. This study aims to analyze the prevalence of potentially nephrotoxic drugs (PND) prescriptions and the association of patients' characteristics with PND prescribing.

Methods: This cross-sectional study employed retrospective data from Universitas Indonesia Hospital (RSUI), focusing on CKD outpatients treated between January 2019 and December 2022. CKD patients over the age of 18 were included, with exclusions for those suspected of having CKD, those with a history of kidney transplants, or missing critical data. The study outcome was the prevalence of patients prescribed PND, determined using reliable references to assess potential nephrotoxicity. Furthermore, compliance with clinical guidelines was evaluated at the individual drug level, with each PND within a prescription treated as a separate case. Descriptive analyses were carried out to determine prevalence, which were presented as percentages. Logistic regression analysis was performed to examine the association between patient characteristics and the prescription of PND.

Results: In total, 248 patients were evaluated. The findings revealed that 177 out of 248 patients (71.4%) were prescribed at least one PND. The categories of these drugs included antihypertensives (50.9%), antigout medications (17.8%), antiplatelets (10.5%), antibiotics (9.8%), NSAIDs (5.8%), and antiulcer agents (5.2%). Of 275 cases of PND prescriptions, 220 (80.0%) complied to treatment guidelines, while 55 (20.0%) did not. Logistic regression analysis indicated that patients taking more than four additional medications were more likely to be prescribed PNDs than those on fewer medications (aOR 2.454, 95% CI 1.399-4.305).

Conclusion: Although non-compliance cases are relatively low, PNDs are frequently prescribed to CKD patients, with the risk rising as the number of comedications increases. Measures are needed to ensure guideline compliance, including accurate dosage assessments and outcome monitoring.